Hemorrhoids pp 19-33 | Cite as

Classification of Hemorrhoidal Disease and Impact on the Choice of Treatment

  • Amy C. LordEmail author
  • Annabel Shaw
  • Philip H. Pucher
Reference work entry
Part of the Coloproctology book series (COLOPROCT, volume 2)


The ideal classification of hemorrhoidal disease remains uncertain, with numerous frameworks proposed. Classification may be based on anatomical findings or symptom severity, with advantages and disadvantages inherent in each. Careful history and examination in an ambulatory setting are required and will be typically coupled with additional investigations to rule out other differentials before a final diagnosis and classification can be reached. Depending on anatomical findings (position of hemorrhoids), various treatment options are recommended which may include lifestyle advice (grade I), ambulatory treatments (grade I–II), or various surgical procedures (grade II–IV). A recommended treatment algorithm is described, but must be considered in the context of symptom severity. Several symptom severity scoring frameworks are described, though validity evidence for these is mixed.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Croydon University Hospital NHS TrustLondonUK
  2. 2.St Mary’s Hospital, Imperial College LondonLondonUK

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