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Internal Hemorrhoids: First- to Fourth-Degree. A first-degree internal hemorrhoid bulges into the anal canal during bowel movements. A second-degree internal hemorrhoid bulges from the anus during bowel movements, then goes back inside by itself. A third-degreehemorrhoid bulges from the anus during bowel movements and must be pushed back in with a finger. A fourth-degree hemorrhoid protrudes from the anus all the time.
Surgery - Recommended for extreme cases of hemorrhoids. The most extreme cases of hemorrhoids stem from what is called prolapsed hemorrhoids. These hemorrhoids have grown to the point where they are an external appendage and cause great discomfort. Many suffering with prolapsed hemorrhoids are recommended by their doctor to consider a surgical approach to their suffering.