The following is a quick summary of treatment for internal hemorrhoids by grade: Grade 1 hemorrhoids are treated with conservative medical therapy and avoidance of nonsteroidal anti-inflammatory drugs and spicy or fatty foods Grade 2 or 3 hemorrhoids are initially treated with nonsurgical procedures Very symptomatic grade 3 and grade 4 hemorrhoids are best treated with surgical hemorrhoidectomy Treatment of grade 4 internal hemorrhoids requires prompt surgical consultation..consult surgeon they will explain in detail.

Hello..... Stapled hemmoroidectomy is done commonly in third and fourth grade hemmoroids..Another alternative is to do a stapled hemorrhoidectomy and a simple excision of the external hemorrhoids. If the external hemorrhoids are large, a standard surgical hemorrhoidectomy may need to be done to remove both the internal and external hemorrhoids.lateral sphincterotomy is not done in this case... I think you got confused ,consult general surgeon.