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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 may also cause anal itching (pruritus ani), and a constant feeling of needing to have a bowel movement (tenesmus). Internal hemorrhoid severity can be graded: Grade I: Prominent blood vessels with no prolapse. Grade II: Prolapse with bearing down but with spontaneous reduction.