How are stage I-IV internal hemorrhoids differentiated?

The differentiation of stage I-IV internal hemorrhoids is primarily based on whether they prolapse. Internal hemorrhoids are categorized as follows:

• Stage I hemorrhoids do not prolapse and are confined within the anal canal.

• Stage II hemorrhoids prolapse but retract spontaneously, meaning they come out during bowel movements but go back in on their own.

• Stage III hemorrhoids also prolapse, but they require manual reduction to return to their original position.

• Stage IV hemorrhoids remain prolapsed and cannot be manually reduced back into the anal canal.

This classification is essential for determining the appropriate management strategy for patients, as the treatment can vary significantly based on the stage of the hemorrhoids and whether they are prolapsing. Other factors such as pain, size, or color can be associated with hemorrhoids but do not play a definitive role in their staging. Thus, the ability of the hemorrhoids to prolapse is a clear and pivotal characteristic that distinguishes the stages.