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First degree: the hemorrhoids remain inside at all times. Second degree: the hemorrhoids extend out of the rectum during a bowel movement but return on their own. Third degree: the hemorrhoids extend out during a bowel movement but can be pushed back inside. Fourth degree: the hemorrhoid is always outside.
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.