What is the main difference between grade 1 and grade 2 hemorrhoids? Everywhere I read irs quite confusing. Some say if they are inside then grade 1, if they come out during defecation and go back themselves then grade 2, of manually have to push them back in then grade 3 and if full time outside then grade 4 Some say grade 1 are small and they're inside them grade 2 are also inside but they are little bigger, grade 3 come out and might go back in and 4 are always out. Grade 1 and grade 2 definition is quite different everywhere