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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.
A hemorrhoidectomy is surgery to remove internal or external hemorrhoids that are extensive or severe. Surgical hemorrhoidectomy is the most effective treatment for hemorrhoids, though it is associated with the greatest rate of complications. Symptomatic grade III, grade IV, or mixed internal and external hemorrhoids.