Stage I: Hemorrhoids do not prolapse out of the anus. Stage II: The hemorrhoid is prolapsed during defecation and can be retracted by itself. Stage III: The hemorrhoid is prolapsed during defecation and needs to be returned by hand. Stage IV: The hemorrhoid prolapses outside the anus for a long time and cannot be retracted or prolapses immediately after retraction. Asymptomatic internal hemorrhoids do not require surgery, but only when they are complicated by bleeding, prolapse, thrombosis and impaction. Stage III and IV internal hemorrhoids mostly require surgery.