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do not prolapse below the dentate line Grade II: prolapse out of the anal canal with defecation or straining but reduce spontaneously Grade III: prolapse out of the anal canal with defecation or straining and require manual reduction Grade IV: irreducible and may strangulate Internal hemorrhoids: Stool softeners, sitz baths Symptomatic treatment is usually all that is needed: stool softeners (e.g., docusate, psyllium), warm sitz baths (i.e., sitting in a tub of tolerably hot water for 10 min) after each bowel movement, and as needed, anesthetic ointments containing lidocaine, or witch hazel (Hamamelis) compresses

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