Do Grade 4 Hemorrhoids Ever Go Away? Everything you need to know.


Do grade 4 hemorrhoids ever go away? The simple answer is now. Grade 4 hemorrhoids, characterized by permanent prolapse through the anus, unfortunately, do not typically go away on their own without treatment.

The constant protrusion of hemorrhoidal tissue tends to progressively worsen over time. However, surgical procedures are very effective at removing or repositioning grade 4 hemorrhoids to provide permanent resolution of the prolapse.

Do Grade 4 Hemorrhoids Ever Go Away? Key Points

  • Grade 4 hemorrhoids rarely resolve without surgery due to constant prolapse.
  • The prolapsed tissue tends to enlarge and cause worsening symptoms over time without treatment. 
  • Corrective surgery removes or repositions hemorrhoids to allow retraction.
  • Extreme lifestyle modifications may occasionally resolve small grade 4 hemorrhoids. 
  • Large, significant grade 4 hemorrhoids require surgery for definitive improvement.
A man holding his buttock due to the pain of hemorrhoids.

Why Don’t Grade 4 Hemorrhoids Spontaneously Resolve?

Weak Anal Sphincters 

In grade 4 hemorrhoids, the anal sphincter muscles have become too weak to be able to retain the prolapsing tissue inside.

This allows constant prolapse through a patulous anus. The muscles require surgical tightening.

Enlarged Hemorrhoidal Tissue

The hemorrhoid tissue itself has enlarged abnormally and protrudes externally. This excess tissue will not shrink without removal.

It continues enlarging without treatment.

Persistent Straining 

Chronic straining and pressure keep the hemorrhoids prolapsed. This does not change unless lifestyle modifications are made to soften stools long-term.

A man holding is belly in pain.

No Treatment of the Underlying Issue

Conservative symptom relief like sitz baths, ointments, and pain medication does not treat the underlying prolapsed hemorrhoids.

Prolapse will persist unless repaired surgically.

Progression Over Time

When left untreated, grade 4 hemorrhoids tend to slowly expand, become further prolapsed, and cause worsening pain and bleeding.

The protruding tissue does not improve.

Can Prolapse Resolve Without Surgery?

In very rare cases, small grade 4 hemorrhoids may retract and seem to resolve spontaneously if constipation and straining are completely eliminated.

However, most patients find it very difficult to sustain these lifestyle changes long-term. Significant grade 4 hemorrhoids will virtually never disappear without surgery.

Surgical Options to Remove Grade 4 Hemorrhoids

There are several surgical options available for the effective treatment of Grade 4 hemorrhoids. Some of the most used techniques are:

  • Hemorrhoidectomy
    Excision of hemorrhoids
  • Hemorrhoidopexy
    Stapled hemorrhoid resection
  • Ligation And Plication
    Suture ligation of hemorrhoids

These techniques allow the removal or repositioning of the problematic tissue, enabling retraction back inside the anal canal.

Final Note From Dr. Rajarshi Mitra

I hope this overview explains why grade 4 hemorrhoids essentially never disappear without surgical intervention.

Surgery reliably allows these hemorrhoids to retract inside and remain in place. Please let me know if you have any other questions!


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  • Anal Fissure
  • Anal Fistula
  • Appendicitis
  • Gallbladder
  • Hemorrhoids
  • Inguinal Hernia
  • Pilonidal Sinus
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Based on 554 reviews
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