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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 a collection of nerves, connective tissue, veins and arteries in the anal wall that often enlarge over time and cause severe pain and discomfort. In certain cases hemorrhoids prolapse, or fall outwards from the anus, which increases the pain associated with the condition.