Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Goligher's classification of internal hemorrhoids provides a systematic way to assess the severity of hemorrhoids based on physical examination findings. This classification helps determine the appropriate treatment strategy by assigning a grade from I to IV.

To use this assessment, consider the following physical findings and corresponding interpretations:

- Prominent hemorrhoidal vessels, no prolapse: This description indicates Grade I hemorrhoids where vessels are noticeable but do not prolapse.
- Prolapse with Valsalva, spontaneous reduction: This finding corresponds to Grade II, where hemorrhoids prolapse during a Valsalva maneuver (like straining) but reduce on their own.
- Prolapse with Valsalva, requires manual reduction: Grade III captures hemorrhoids that need manual assistance to reduce after prolapsing during a Valsalva maneuver.
- Chronically prolapsed, manual reduction ineffective: This scenario describes Grade IV hemorrhoids, which are constantly prolapsed and cannot be reduced manually.

Upon examining these physical findings, a practitioner can assign the appropriate grade to the hemorrhoids:

- If the finding matches "Prominent hemorrhoidal vessels, no prolapse," you classify it as Grade I.
- If the observation is "Prolapse with Valsalva, spontaneous reduction," assign Grade II.
- When the finding is "Prolapse with Valsalva, requires manual reduction," it corresponds to Grade III.
- If the condition is "Chronically prolapsed, manual reduction ineffective," classify it as Grade IV.

This structured approach allows healthcare providers to efficiently classify hemorrhoids, guiding the appropriate management or intervention based on established clinical standards.

Goligher's classification of internal hemorrhoids is a clinical tool designed for the grading and management of internal hemorrhoids. This classification system is based on the physical findings of hemorrhoidal vessels and their behavior during a Valsalva maneuver, which is a forced exhalation against a closed airway, often used in clinical settings to evaluate the condition of the heart and lungs.

The primary components of this classification system include the prominence of hemorrhoidal vessels and the presence and degree of prolapse. The system classifies hemorrhoids into four grades. Grade I is characterized by prominent hemorrhoidal vessels without prolapse. Grade II hemorrhoids prolapse with a Valsalva maneuver but reduce spontaneously. Grade III hemorrhoids also prolapse with a Valsalva maneuver but require manual reduction. Finally, Grade IV hemorrhoids are chronically prolapsed and cannot be manually reduced.

The clinical utility of Goligher's classification lies in its ability to guide treatment decisions. The grade of hemorrhoids can influence the choice of therapeutic interventions, ranging from conservative management for lower grades to surgical interventions for higher grades. This classification system also provides a standardized language for clinicians to communicate about the severity and management of internal hemorrhoids.

Hemorrhoids

Guidelines

Key sources