Prolapsed Hemorrhoid Symptoms and Treatment

Self-Care and When to See the Doctor

Rough toilet paper
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Prolapsed hemorrhoids are internal hemorrhoids that protrude out of the rectum. It is not common for these to cause pain, though you may notice bleeding. In many cases, prolapsed hemorrhoids will reduce on their own or through proper self-care, though it's best to consult your doctor.

What Are Prolapsed Hemorrhoids?

Hemorrhoids are swollen veins that support the muscles of your anal sphincter. These swell up as needed to help to keep stool from leaking out or when there is increased pressure on the veins from straining or pregnancy. Prolapsed means an internal structure has fallen down or slipped out of place. Hemorrhoids are classified as internal or external depending on where they lie on your rectum.

A hemorrhoid is considered to be prolapsed when there is protrusion beyond the rectum. 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.

Symptoms 

The symptoms of prolapsed hemorrhoids are typical as follows:

  • Bleeding, typically bright red, that occurs with a bowel movement. This blood may be seen in the stool, dripped into the toilet bowl, or on toilet paper.
  • Itching of the perineum or the anus.
  • Large prolapsed hemorrhoids may trigger a feeling of incomplete evacuation.
  • Pain may be present if thrombosis or strangulation occurs.

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

Pain From Prolapsed Hemorrhoids

Prolapsed hemorrhoids are typically pain-free. You may experience pain for a few reasons. For instance, if swelling (edema) has formed within hemorrhoid, this may put additional pressure on the area that causes pain.

It is also possible that your hemorrhoid has become thrombosed, meaning a blood clot has formed. This is more of a risk with Grade IV hemorrhoids and external hemorrhoids. Hemorrhoids may also become strangulated if the blood supply has been blocked due to pressure from the anal sphincter.

Diagnosis 

Prolapsed hemorrhoids can be identified by your physician during a rectal examination. Your doctor may also perform a sigmoidoscopy to get a better picture as to what might be happening in your rectum.

Treatment

Most prolapsed hemorrhoids spontaneously reduce or can be encouraged to reduce through self-care. This includes the use of ice packs, sitz baths, and over-the-counter remedies. It is important to avoid straining during bowel movements. You should also work to keep your stools soft by eating foods high in fiber, taking a stool softener or fiber supplement, and drinking water and nonalcoholic liquids.

For cases in which hemorrhoids do not spontaneously reduce, or when they tend to recur frequently, there are a variety of medical treatments for prolapsed hemorrhoids. Your doctor will determine which treatment is best for you based on your history and severity of symptoms.

Some of these options are relatively non-invasive, including the most common non-operative treatment of rubber band ligation. There are other less invasive, non-surgical options available as well. In addition, there are several surgical options that might be recommended due to the severity of your symptoms.

Sources

Lohsiriwat V. Hemorrhoids: From Basic Pathophysiology to Clinical Management. World Journal of Gastroenterology. 2012;18:2009–2017.

Sanchez C, Chinn B. Hemorrhoids. Clinics in Colon and Rectal Surgery. 2011;24:5–13.

Treatment of Hemorrhoids. National Institute of Diabetes, Digestive, and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/treatment.