Goligher Classification

In brief: The Goligher classification grades internal hemorrhoids from I to IV according to prolapse and whether it reduces spontaneously or manually.

Use in hemorrhoids

Grade I describes internal hemorrhoids without prolapse. Grade II prolapses with straining and returns spontaneously. Grade III requires manual reduction. Grade IV remains prolapsed and cannot be manually reduced. The ASCRS guideline uses prolapse grade as one part of selecting conservative, office, or operative care. [1]

Clinical detail

Goligher grade is not an overall severity score. It does not measure bleeding volume, pain, external thrombosis, circumferential extent, continence, quality-of-life impact, or another diagnosis. Grades can vary with examination conditions and patient description, so treatment should not be chosen from the numeral alone.