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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.
Hemorrhoids are swollen blood vessels of the rectum. The hemorrhoidal veins are located in the lowest area of the rectum and the anus. Sometimes they swell so that the vein walls become stretched, thin, and irritated by passing bowel movements. Hemorrhoids are classified into two general categories: internal and external. Internal hemorrhoids lie far enough inside the rectum that you can't see or feel them. They don't usually hurt because there are few pain-sensing nerves in the rectum. Bleeding may be the only sign that they are there. Sometimes internal hemorrhoids prolapse, or enlarge and protrude outside the anal sphincter.