An Overview of Prolapsed Hemorrhoids

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Prolapsed hemorrhoids occur when internal hemorrhoids (in the rectum) or external hemorrhoids (in the anus) bulge outside the anal opening. They can cause pain, bleeding, and other symptoms that can interfere with sitting, using the bathroom, and going about daily life comfortably. In many cases, prolapsed hemorrhoids may reduce (shrink) on their own or with at-home treatment strategies, but some require medical or surgical treatment.

Symptoms

The symptoms of prolapsed hemorrhoids can vary. They can protrude and shrink intermittently, so you may only notice them sometimes.

The most common symptoms include:

  • A lump: You may feel a bump on your anus when you wipe after a bowel movement. This is the swollen vein, and it may be tender to the touch, tender all the time, or painless.
  • Bleeding: You may notice blood in the toilet or on the toilet paper when you have a bowel movement, or even on your underwear in between bowel movements. The blood is typically bright red and very watery, as opposed to blood that comes from the stomach or from intestinal bleeding, which is usually dark, black, or tarry.
  • Itching: The skin around your anus may be very itchy when you have a prolapsed hemorrhoid.
  • Discomfort: Large prolapsed hemorrhoids may trigger a general feeling of discomfort or a sense of incomplete evacuation of your bowels, even when you don't have to release stool.
  • Pain: There may be tenderness when a bowel movement or anything else touches your hemorrhoid. The pressure of sitting down may also irritate it.

Complications

A prolapsed hemorrhoid may become severely swollen, obstructing your bowel movements.

It can suddenly bleed profusely, causing blood loss, a drop in blood pressure, and a rapid heart rate. Hemorrhoids may also become thrombosed (forming a blood clot) or strangulated (becoming cut off from blood supply). This typically causes pain.

Prolapsed hemorrhoids are more likely to bleed or become thrombosed or strangulated than hemorrhoids that are not prolapsed.

See your doctor immediately if you have severe pain or heavy bleeding from your rectum, especially if you have abdominal discomfort, diarrhea, or a fever.

Causes

Hemorrhoids can form in the anus or rectum as a result of increased pressure on the veins in these areas. There are several well-identified causes of hemorrhoids, and when they are untreated, last for a prolonged period of time, or are under more physical pressure, they can become prolapsed and protrude out of the anus or rectum.

A high-fat/low-fiber diet, dehydration, lack of physical activity, iron supplements, diarrhea, overuse of anti-diarrhea medications, and gastrointestinal disease can all cause hemorrhoids to prolapse.

Sometimes, placing something in the anus, such as during sexual activity, or for medical treatment, can cause pressure, resulting in prolapse of a hemorrhoid as well.

Constipation, pregnancy, and obesity are risk factors for prolapsed hemorrhoids. They can worsen during the postpartum period, in the weeks and months after you have a baby.

Diagnosis 

A hemorrhoid is considered to be prolapsed when there is protrusion beyond the rectum. Prolapsed hemorrhoids can be identified by your physician during a rectal examination. Your doctor may need to perform a sigmoidoscopy to see if there are hemorrhoids inside your rectum as well.

Internal hemorrhoids are classified depending on the level of protrusion:

  • Grade I: These internal hemorrhoids are prominent but do not protrude into the anal canal. Bleeding may occur.
  • Grade II: These internal hemorrhoids prolapse out of the anal canal during a bowel movement, but spontaneously retract back inside.
  • Grade III: These internal hemorrhoids prolapse during a bowel movement or other forms of exertion and have to be manually returned inside.
  • Grade IV: These internal hemorrhoids have prolapsed out of the anal canal and cannot be pushed back in, nor do they remain inside the rectum. Grade IV hemorrhoids may become strangulated if the blood supply becomes been blocked due to pressure from the anal sphincter.

Treatment

Most prolapsed hemorrhoids spontaneously reduce, but you may need at-home remedies, medication, or surgery if your hemorrhoid does not improve on its own.

Self-Care

Self-care strategies such as ice packs and sitz baths can help prolapsed hemorrhoids shrink.

It is important to avoid straining during bowel movements. You can keep your stools soft by eating foods high in fiber and drinking plenty of water.

Staying active, and especially walking regularly, can help prevent worsening of a prolapsed hemorrhoid. Alcohol and caffeine are dehydrating, so it can help to avoid them when you are dealing with a prolapsed hemorrhoid.

Medication

If your hemorrhoids do not spontaneously reduce, or if they recur, there are a variety of medical treatments you can use, including over-the-counter topical ointments and stool softeners. Your doctor can give you a prescription for a stool softener if the over-the-counter medications don't help.

Interventional Procedures

Several procedures can shrink, remove, or decrease blood flow to a prolapsed hemorrhoid that cannot be treated with more conservative measures.

The most common procedure for treatment of a prolapsed hemorrhoid is a rubber band ligation, which cuts off blood flow to the vein by wrapping a band around it. This results in shrinking of the hemorrhoid.

Other options include:

  • Sclerotherapy: The injection of a material that causes the vein to shrink
  • Coagulation: The use of an infrared light to cut off blood supply to the vein, causing it to shrink

Surgery is a more invasive way to tie off or remove a prolapsed hemorrhoid, and that may be necessary if your prolapsed hemorrhoid can't be treated with the other options.

A Word From Verywell

Hemorrhoids are very common, and prolapsed hemorrhoids are also not unusual. They typically improve on their own, but they can persist, necessitating medical or surgical intervention. Healthy lifestyle habits can help prevent prolapsed hemorrhoids from developing in the first place, and often, adopting healthy habits can shrink them permanently.

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