Severe Bleeding From Hemorrhoids: Serious Signs You Should Not Ignore

Understanding Grade 3 & Grade 4 Hemorrhoids: Symptoms, Causes, and Treatment Options

Grade 3 hemorrhoids and Grade 4 hemorrhoids represent the most advanced stages of the condition, often bringing significant discomfort, bleeding, and difficulty during bowel movements. At these stages, the swollen veins around the anus or inside the rectum prolapse severely, meaning they bulge out and typically require manual repositioning — or in Grade 4, cannot be pushed back inside at all. While early hemorrhoids may respond to simple home remedies, Grade 3 and 4 hemorrhoids usually need more structured, medical-level care to restore comfort and prevent complications.

Grade 3 and Grade 4 Hemorrhoids illustration

Because advanced hemorrhoids share certain symptoms with other anorectal conditions, understanding how they progress — and how they differ from milder forms — is essential for getting proper diagnosis and effective treatment. In this guide, you’ll learn what sets Grade 3 and Grade 4 hemorrhoids apart, why they happen, and the most effective treatments available today. You’ll also find helpful internal links to related articles such as prolapsed hemorrhoids and internal hemorrhoids to help you build a complete understanding of this condition.

What Are Grade 3 and Grade 4 Hemorrhoids?

Hemorrhoids are graded based on how far they protrude from the anus and how easily they return inside. Grade 3 and 4 fall under the severe end of the spectrum, meaning the supporting tissues have weakened significantly and the swollen veins cannot stay inside the anal canal on their own.

Grade 3 Hemorrhoids

Grade 3 hemorrhoids prolapse (bulge out) during bowel movements or when straining. However, they can still be manually pushed back into the rectum. People with Grade 3 hemorrhoids often report pain, bleeding, and a persistent feeling of fullness or pressure around the anus. While not considered a full emergency, Grade 3 hemorrhoids typically require medical intervention because lifestyle changes and home remedies rarely resolve the issue completely.

Grade 4 Hemorrhoids

Grade 4 hemorrhoids are permanently prolapsed and cannot be pushed back inside, even manually. This stage is often accompanied by intense pain, swelling, bleeding, and a higher risk of complications such as strangulation or clot formation. Grade 4 hemorrhoids typically require surgical treatment to prevent further deterioration, restore normal function, and relieve pain.

Common Symptoms

Although symptoms may vary depending on the severity, Grade 3 and 4 hemorrhoids typically present with:

  • Persistent prolapse that does not stay inside the rectum on its own
  • Bright red rectal bleeding
  • Significant swelling or a noticeable lump around the anus
  • Pain and discomfort during or after bowel movements
  • Mucus leakage and irritation
  • Difficulty cleaning after bowel movements

These symptoms overlap somewhat with related conditions like prolapsed hemorrhoids, but Grade 3 and 4 hemorrhoids represent more advanced and persistent prolapse that requires targeted care.

Causes of Grade 3 and Grade 4 Hemorrhoids

Advanced hemorrhoids almost always begin as mild internal hemorrhoids that worsen over time if not treated properly. Several factors contribute to progression:

  • Chronic straining during bowel movements
  • Long-term constipation or diarrhea
  • Low-fiber diet leading to hard stools
  • Pregnancy, which increases pelvic pressure
  • Heavy lifting or frequent high-pressure activities
  • Obesity causing increased pressure around the rectal area

Without early treatment or prevention, the supporting tissues surrounding the hemorrhoidal veins weaken, making prolapse more likely and more difficult to reverse once it becomes severe.

Diagnosis

A healthcare provider will usually diagnose Grade 3 or Grade 4 hemorrhoids with a simple visual exam. In some cases, internal examination tools may be used to confirm the severity and rule out other conditions such as polyps, fissures, or rectal prolapse. Medical evaluation is crucial for determining the right treatment plan and preventing complications.

Treatment Options for Grade 3 Hemorrhoids

Grade 3 hemorrhoids can sometimes be managed with minimally invasive in-office procedures. Common treatments include:

Rubber Band Ligation (RBL)

A small rubber band is placed around the base of the hemorrhoid to cut off blood flow. The hemorrhoid shrinks and falls off within a few days. This is one of the most effective treatments for Grade 3 hemorrhoids.

Sclerotherapy

A medicated solution is injected into the hemorrhoid to shrink it. This option is typically used when RBL is not suitable.

Infrared Coagulation

A heat-based procedure used to shrink hemorrhoidal tissue. While effective for some Grade 3 cases, it may not work for larger prolapses.

Your doctor will recommend the most appropriate treatment depending on the degree of prolapse, bleeding, and overall health status.

Treatment Options for Grade 4 Hemorrhoids

Grade 4 hemorrhoids generally require surgical intervention because they cannot be repositioned manually and carry a higher risk of complications.

Hemorrhoidectomy

This is the most common and effective surgery for Grade 4 hemorrhoids. The surgeon removes the swollen tissue completely, offering long-term relief. Recovery takes longer than minimally invasive options, but success rates are very high.

Stapled Hemorrhoidopexy

This procedure uses a circular stapling device to reposition and secure the hemorrhoidal tissue back into place. It causes less postoperative pain than a traditional hemorrhoidectomy but may not be suitable for all Grade 4 cases.

Severe cases should be assessed by a colorectal specialist to ensure the safest and most effective treatment approach.

Home Care and Pain Relief

While home remedies cannot cure Grade 3 or Grade 4 hemorrhoids, they can help reduce symptoms while awaiting medical treatment. Warm sitz baths, witch hazel pads, cold compresses, and proper hygiene can offer temporary relief. For detailed natural remedies for milder hemorrhoids, you may also look at informational pages like our parent category Types of Hemorrhoids for better context on how hemorrhoids progress from mild to severe stages.

Prevention After Treatment

After undergoing treatment, it’s essential to adopt healthy lifestyle habits to prevent recurrence:

  • Increase dietary fiber intake
  • Stay hydrated throughout the day
  • Avoid prolonged sitting on the toilet
  • Exercise regularly to promote better bowel function
  • Use fiber supplements as needed

Making these changes reduces strain on rectal veins and lowers the chance of future hemorrhoid flare-ups.

When to Seek Medical Attention

According to the Mayo Clinic, severe hemorrhoids that cannot be manually repositioned, cause persistent bleeding, or produce intolerable pain should always be evaluated by a medical professional. Delaying care for Grade 4 hemorrhoids, in particular, increases the risk of complications such as infections, strangulation, or anemia.

Final Thoughts

Grade 3 and Grade 4 hemorrhoids are challenging conditions that require proper medical evaluation and targeted treatment. While lifestyle changes help with symptom management, these advanced stages often need procedural or surgical intervention to achieve long-term relief. If you’re experiencing severe prolapse, bleeding, or persistent discomfort, consult a healthcare provider right away for appropriate diagnosis and care.