What Is a Grade 3 Hemorrhoid? Symptoms and Treatment

Everyone has hemorrhoids. They are cushions of blood vessels inside the anus, and they only cause trouble when they swell and start to slip out of place. Doctors rate that slipping on a four-step scale, and grade 3 sits near the top: the tissue comes out with straining and no longer goes back on its own. The real decision is between quicker, gentler treatments and surgery that is more likely to last.

How Grade 3 Differs From the Other Grades

The grading scale applies only to internal hemorrhoids. These sit higher inside the anal canal than external hemorrhoids, which lie under the skin around the opening.1Cleveland Clinic Journal of Medicine. Hemorrhoids: The Definitive Guide to Medical and Surgical Treatment Internal hemorrhoids are graded by how far they slip out.

Needing to push the tissue back shows that the tissue holding the cushions in place has stretched and weakened.6Pristyn Care. Grade 3 Piles Treatment: Symptoms, Causes & Surgery Options7Pristyn Care. Grade 3 Piles Treatment: Symptoms, Causes & Surgery Options At home, you can tell grade 2 from grade 3 by what happens after a bowel movement. If the lump goes back up within moments without any help, that fits grade 2. If you routinely press it back with a finger or tissue, that matches grade 3. Only a doctor’s exam confirms the grade, since the hemorrhoid can look different when you strain. Your grade can also change over time, so mention it if pushing the tissue back gets harder.

The grade matters because it steers treatment. Grades 1 and 2 often settle with diet changes and simple treatments. Grade 3 is where banding and surgery become the main conversation, and grade 4 usually points toward surgery.

Symptoms of a Grade 3 Hemorrhoid

Common complaints with hemorrhoids include bleeding, pain, anal discomfort, discharge and itching.8PubMed. Micronized purified flavonoid fraction in the treatment of hemorrhoidal disease Bleeding from internal hemorrhoids is usually painless and bright red, and you see it on the toilet paper or in the bowl. A hemorrhoid that has slipped out can leave mucus that dampens underwear and irritates the skin, which causes itching. A grade 3 lump is usually soft, moist and pink or dark red.

How much hemorrhoids affect daily life does not match the grade a doctor assigns.9PubMed Central. Quality of life in patients with hemorrhoidal disease A grade 3 hemorrhoid can bother one person mildly and another a lot, which is why treatment is often based on how you feel.

Bleeding needs checking, because rectal bleeding can come from other diseases, including colorectal cancer.10Cleveland Clinic Journal of Medicine. Hemorrhoids: The Definitive Guide to Medical and Surgical Treatment People at higher risk of colon cancer may need a scope exam such as a colonoscopy before hemorrhoids get the blame.11Cleveland Clinic Journal of Medicine. Hemorrhoids: The Definitive Guide to Medical and Surgical Treatment

Some signs point away from hemorrhoids. Bowel habit changes that last weeks deserve a check. So does unexplained weight loss or tiredness alongside bleeding, and a family history of colon cancer raises the case for a scope. Sharp, tearing pain during stools suggests a fissure instead. Skin tags, warts, polyps and other growths, including cancers, can feel like hemorrhoids, so a lump that has never been examined should be looked at by a clinician.

A few signs need same-day care. Sudden severe pain with a hard lump that won’t go back in may mean a stuck or clotted hemorrhoid. Heavy bleeding or dizziness needs urgent care. Dark, tarry or maroon stool suggests bleeding from higher up in the digestive tract, and fever with anal pain can signal infection.

Treatments You Can Start Without a Procedure

Flavonoids are plant-based vein-strengthening pills, sold in many countries under names such as diosmin. They can reduce bleeding, pain, discomfort, discharge and itching during a flare.12PubMed. Micronized purified flavonoid fraction in the treatment of hemorrhoidal disease In a study of people with grades 2 to 4, bleeding often cleared within the first week on flavonoids.13PubMed Central. Comparison of Centella with Flavonoids for Treatment of Symptoms in Hemorrhoidal Disease and After Surgical Intervention: A Randomized Clinical Trial They were safe and well tolerated, with no complications reported.14PubMed Central. Comparison of Centella with Flavonoids for Treatment of Symptoms in Hemorrhoidal Disease and After Surgical Intervention: A Randomized Clinical Trial

They can sometimes lower the grade, too. After 30 days of oral vein-strengthening pills, more than half of people with grade 3 improved to grade 2.15PubMed Central. Evaluating the effectiveness of oral phlebotonics for the conservative management of hemorrhoidal disease: insights from the VIVI2022/01/VIVALDI study That still left many at grade 3, and grade 2 means the tissue still slips out. So flavonoid pills are best seen as a way to calm symptoms and possibly buy time, not a guaranteed fix.

Bowel habits matter as well. Non-surgical care improved stool-related problems and leakage in people with hemorrhoids.16PubMed Central / Lippincott Williams & Wilkins. The Effect of Nonoperative Management of Chronic Anal Fissure and Hemorrhoid Disease on Bowel Function Patient-Reported Outcomes

Aim for about 25 to 35 grams of fiber a day, from food or a psyllium supplement. Beans, lentils, oats, berries, pears, vegetables and whole grains are good sources, and psyllium can fill the gap if food alone isn’t enough. Add it gradually over a couple of weeks, because jumping up quickly can cause gas and bloating that make people give up. It takes days to weeks to show its full effect, so judge it over a few weeks. Drink enough water, and take any fiber supplement with a full glass, since fiber with too little fluid can leave stool harder.

Toilet habits help too. Don’t sit scrolling your phone; get up if nothing happens. A footstool that raises your knees can make passing stool easier.

Over-the-counter creams soothe itching and burning but don’t fix the slipping. Steroid creams should be used only for a short course. A warm sitz bath for 10 to 15 minutes eases soreness, and gently pushing the hemorrhoid back with a lubricated finger after stools reduces irritation.

Rubber Band Ligation for Grade 3

In rubber band ligation, a doctor places a tight band at the base of the hemorrhoid. That cuts off its blood supply, so it shrinks and falls off within about a week. It is done in a clinic without general anesthesia, in a few minutes.

You lie on your side while the doctor passes a small scope into the anal canal and uses a device to set the band. The area usually banded has few pain-sensing nerves, so people often describe pressure or a pinch rather than sharp pain. One to three hemorrhoids are often banded per visit, and if you have more, the doctor may spread them over separate visits. You can usually go home right away, though many people rest for the rest of the day. A dull ache or pressure for a day or two is common, and some bleeding when the band falls off about a week later is expected.

For grade 3, one banding session was enough for about half of people.17PubMed Central. Hemorrhoidectomy versus rubber band ligation in grade III hemorrhoidal disease: a large retrospective cohort study with long-term follow-up Of those who needed more, about 7 in 10 had a second banding within a year and about 3 in 10 went on to surgery.18PubMed Central. Hemorrhoidectomy versus rubber band ligation in grade III hemorrhoidal disease: a large retrospective cohort study with long-term follow-up Hemorrhoids came back in about 15% after banding versus about 5% after removal surgery, in grade 2 and 3 cases.19TAJ: Journal of Teachers Association. Comparative Analysis of Hemorrhoidectomy and Rubber Band Ligation in Grade II-III Internal Hemorrhoids: A Long-Term Outcome Study

Complications were about half as common after banding as after surgery, 7% versus 14%.20TAJ: Journal of Teachers Association. Comparative Analysis of Hemorrhoidectomy and Rubber Band Ligation in Grade II-III Internal Hemorrhoids: A Long-Term Outcome Study People were also more satisfied with banding, about 89% versus 73%.21TAJ: Journal of Teachers Association. Comparative Analysis of Hemorrhoidectomy and Rubber Band Ligation in Grade II-III Internal Hemorrhoids: A Long-Term Outcome Study That is why many people try banding first and keep surgery as a backup.

Call your doctor for severe pain that worsens instead of fading, trouble passing urine, heavy bleeding with clots, or fever or chills; these problems are rare but serious.

Surgery Options for Grade 3

Hemorrhoidectomy, cutting out the hemorrhoids, is the standard operation for grade 3 and 4.22MVP Journal of Medical Sciences. A Comparative Study of Open (Milligan-Morgan) Versus Closed (Ferguson) Hemorrhoidectomy It worked as a single procedure in about 96% of grade 3 cases.23PubMed Central. Hemorrhoidectomy versus rubber band ligation in grade III hemorrhoidal disease: a large retrospective cohort study with long-term follow-up It can be done leaving the wounds open or closing them with dissolving stitches.24MVP Journal of Medical Sciences. A Comparative Study of Open (Milligan-Morgan) Versus Closed (Ferguson) Hemorrhoidectomy The closed method had shorter hospital stays, 3 days versus 5, along with less pain and faster healing.25MVP Journal of Medical Sciences. A Comparative Study of Open (Milligan-Morgan) Versus Closed (Ferguson) Hemorrhoidectomy

Removal takes out the hemorrhoid tissue and the stretched tissue with it, so little is left to slip out. That is why it has the lowest chance of return. The price is a harder recovery, with more pain and a longer wait before you feel normal than after banding. It is done in an operating room under anesthesia.

Stapled surgery removes a ring of loose lining above the hemorrhoids and lifts them back into place instead of cutting them out.26PubMed Central. Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III–IV Prolapsing Hemorrhoids But hemorrhoids come back more often over the long term than after traditional removal.27PubMed. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery

Another approach uses ultrasound to find and tie off the arteries feeding the hemorrhoids, then stitches the slipping tissue back up.28PubMed. Doppler-guided ligation of hemorrhoidal arteries with mucopexy: A technique for the future It is safe and effective for grades 2 to 4, with the lifting stitches key for prolapse.29PubMed Central. Doppler-guided hemorrhoidal dearterialization/transanal hemorrhoidal dearterialization: Technical evolution and outcomes after 20 years Laser treatment shrinks hemorrhoids with heat from inside.30Surgery, Gastroenterology and Oncology. Preliminary Outcomes of Laser Hemorrhoidoplasty for Hemorrhoidal Disease at Hanoi Medical University Hospital

Removal surgery suits people who want the lowest chance of return, and large or several hemorrhoids may favor it. Failed banding often leads to surgery as well. Gentler methods suit those who can’t take long off, and surgery is often considered when other problems around the anus need fixing at the same time.

It helps to ask your surgeon which method they use most often and why it fits you, and what their recurrence rate is for patients like you. Also ask how much time off work to expect, and whether it is day surgery or an overnight stay.

Recovery After Hemorrhoid Surgery

Much of the pain comes from the anal muscle tightening into spasm.31PubMed Central. Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review Diltiazem ointment relaxes that muscle.32Hormozgan Medical Journal. The Effect of Topical Diltiazem on Post-Hemorrhoidectomy Pain: A Cohort Study It reduced pain on days 1 to 4 with few side effects,33PubMed Central. Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review and people using it needed fewer pain pills.34Hormozgan Medical Journal. The Effect of Topical Diltiazem on Post-Hemorrhoidectomy Pain: A Cohort Study Ask whether it is available to you. Opioid pain pills can cause constipation, so use them only as needed alongside stool softeners. Ice packs help early swelling.

About 1 in 7 people had trouble passing urine after surgery.35PubMed Central. Predictors of postoperative urinary retention after semiclosed hemorrhoidectomy Risk was higher in men, older people, those with more hemorrhoids removed, and those taking extra pain medicines.36PubMed Central. Predictors of postoperative urinary retention after semiclosed hemorrhoidectomy Tell staff right away if you can’t pass urine within several hours of surgery.

Narrowing of the anus at three months affected about 5% after open or stapled surgery.37PubMed Central. Comparative Study of Postoperative Outcomes and Morbidity Among Laser, Open, and Stapled Hemorrhoidectomy for the Treatment of Grade III and Grade IV Hemorrhoids All cases settled without further surgery.38PubMed Central. Comparative Study of Postoperative Outcomes and Morbidity Among Laser, Open, and Stapled Hemorrhoidectomy for the Treatment of Grade III and Grade IV Hemorrhoids

The first bowel movement is often the most dreaded and the most painful, so take stool softeners as directed and don’t skip them out of fear. Warm sitz baths several times a day, especially after bowel movements, ease pain and keep the area clean. Some bleeding and discharge for the first couple of weeks is normal, and it can be heavier after a bowel movement. Many people with desk jobs return in one to two weeks, though physical work often takes longer. Call for fever, heavy bleeding, or pain that gets worse.

Keeping Grade 3 Hemorrhoids From Coming Back

Whatever treatment you choose, the habits that prevent straining keep working for you.39TAJ: Journal of Teachers Association. Comparative Analysis of Hemorrhoidectomy and Rubber Band Ligation in Grade II-III Internal Hemorrhoids: A Long-Term Outcome Study Keep up fiber and fluids permanently rather than stopping once the area has healed, because the same hard stools that helped cause the problem will make it return. Avoid holding your breath and bearing down when you lift heavy things, since that raises pressure in the abdomen and pushes on the anal cushions. Go when you feel the urge, as putting it off lets stool dry out and become harder to pass. Treat constipation early with a stool softener or extra fiber, rather than waiting until you are straining.

Watch for new bleeding, or a lump that comes out with straining. Early return visits often allow banding rather than surgery.