Symptoms, causes, and treatments for prolapsed hemorrhoids

A prolapsed hemorrhoid is a swollen vein inside the rectum that suddenly protrudes outside the anus (prolapse). These are different from external hemorrhoids, which develop on or around the skin of the anus, and internal hemorrhoids, which remain inside the rectum.

Prolapsed hemorrhoids are usually not painful, but they can cause bleeding, itching, and discomfort, especially when sitting or having a bowel movement. Although most do not cause complications, some severe prolapsed hemorrhoids are known to rupture, form blood clots, or become trapped in the anal muscles, cutting off blood flow ( strangulation).

Prolapsed hemorrhoids often shrink on their own or resolve with simple home remedies. For those who don’t, medication or surgery may be required.

This article details the symptoms, causes, diagnosis, and treatment of prolapsed hemorrhoids.

Symptoms of prolapsed hemorrhoids

Common symptoms of prolapsed hemorrhoids include:

• painless lump: Soft, painless bumps are often first discovered when you are wiping after a bowel movement. When examined, the bump protrudes outside the rectal opening, called the anus.
• bleeding: Bright red blood on the toilet paper or the stool itself is common with prolapsed hemorrhoids. Dark red blood indicates that the bleeding is located further up the colon (large intestine).
• itching and irritation: Anal itching is common with prolapsed hemorrhoids. The skin around the anus may become rough and inflamed.
• mucus discharge: This whitish, pasty mucus can occur as a result of inflammation of the rectum. After wiping, mucus may stick to your stool or toilet paper.
• Bad smell: The presence of mucus can cause a foul odor.
• incomplete evacuation: It feels like your intestines are still full even after defecating.
• stool leakage: Also known as fecal incontinence, this is caused by a protrusion of tissue outside the anus, causing traces of stool to leak out.

Complications of prolapsed hemorrhoids

Prolapsed hemorrhoids can become severely swollen, obstruct bowel movements, and cause heavy bleeding. If the hemorrhoid is large, rupture of the underlying veins can cause severe bleeding and a sudden drop in blood pressure, which can cause dizziness, lightheadedness, and in rare cases, shock and death.

Other serious complications of prolapsed hemorrhoids include:

• venous thrombosis: This is a condition in which a blood clot forms within the veins of a hemorrhoid, blocking blood flow and causing painful swelling of the tissue. Some thrombosed hemorrhoids are the size of a grape or larger.
• confinement and strangulation. This is a condition in which the hemorrhoid becomes trapped (incarcerated) in the anal muscles, completely blocking blood flow (strangulation). This can cause severe pain, rapid tissue death, and gangrene.

What causes prolapsed hemorrhoids?

It is unknown why some people get hemorrhoids while others do not. Although many factors can contribute to the development of hemorrhoids, the ultimate cause is destruction of the supporting tissue within the anal canal.

If hemorrhoids are not treated, persist for a long time, or are subject to extreme blood vessel pressure (such as from straining or coughing), they may prolapse.

Risk factors for prolapsed hemorrhoids include:

• senior citizen
• chronic constipation
• chronic diarrhea
• high fat, low fiber diet
• lack of physical activity
• obesity
• Excessive use of antidiarrheal drugs
• During pregnancy (especially after childbirth)

diagnosis

When a hemorrhoid protrudes outside the rectum, it prolapses. Your health care provider can identify these through a physical examination of your anus.

Internal hemorrhoids are classified into the following two types depending on the degree of protrusion.

• grade 1: These are prominent but do not protrude into the anal canal. Bleeding may occur.
• grade 2: It pops out of the anal canal during defecation, but returns to the anal canal naturally.
• grade 3: These stick out during defecation (or other physical activity) and must be pushed back in with your hands.
• grade 4: These protrude from the anal canal and cannot be pushed back.

Grade 4 hemorrhoids have a high risk of strangulation and most often require professional treatment, including surgery.

Treatment of prolapsed hemorrhoids

Most prolapsed hemorrhoids shrink on their own, but if the condition worsens or does not improve, home treatments, medications, or surgery may be required.

self care treatment

The following self-care strategies can help shrink prolapsed hemorrhoids or prevent them from worsening.

• ice application: Applying a cold compress to the anus for 15 minutes several times a day will reduce swelling.
• Sitz bath. Soaking in a warm bath for 10 to 15 minutes can help reduce discomfort.
• high fiber diet: Eating foods high in fiber and drinking plenty of water can help keep your stools soft. Dietary fiber supplements may also be helpful.
• toilet habits: Avoid straining during defecation. To reduce irritation, wash the anus with a spray bottle after defecating and dab it with toilet paper or baby wipes.
• gentle exercise: Regular gentle exercise such as walking can help prevent constipation. Avoid weight lifting, squatting, and sit-up exercises that put stress on your anus and rectum.
• Avoid straining when defecating. Keep your stools soft by eating foods high in fiber and drinking plenty of water. We recommend drinking 8 glasses of water a day and consuming 25 to 35 grams of fiber a day.

medicine

There are a variety of over-the-counter (OTC) and prescription medications that can help if your hemorrhoids don’t get better or come back.

• OTC ointments and creams: These include products like Preparation H and Dr. Butler’s Hemorrhoid Fissure Ointment, which contain ingredients like lidocaine to numb pain and phenylephrine to constrict dilated veins.
• OTC stool softener: Also known as an emollient laxative, it contains ingredients such as Docusate Sodium, which can change the consistency of your stool so it can absorb more water. These include brands such as Colace, Correctol, Ex-Lax Stool Softener, and Fleet Sof-Lax.
• prescribed topical ointment: Topical preparations of hydrocortisone and pramoxine can help reduce the size of hemorrhoids and numb the surrounding area. Brands include Proctofoam HC, Epifoam, and Analpram-HC.

expert steps

If conservative measures fail, several professional procedures can be performed to shrink or eliminate prolapsed hemorrhoids.

• rubber band ligation: Wrapping the band tightly around the hemorrhoid blocks blood flow to the hemorrhoid’s veins and shrinks the hemorrhoid.
• sclerotherapy: This involves injecting a sclerosing agent that creates a wound in the vein and forces the blood to be rerouted to a healthier vein.
• infrared coagulation: Uses infrared light as a heat source to coagulate (coagulate) the veins, cutting off the blood supply.

hemorrhoid surgery

Surgery is a more invasive method for tying off and removing prolapsed hemorrhoids. Surgery may be necessary if prolapsed hemorrhoids are severe or if other treatments are not effective.

There are different types of surgeries that can be used.

• hemorrhoidectomy: This is a standard surgical procedure performed using a scalpel and sutures. Local, local, or general anesthesia may be used. Recovery time is 2 to 6 weeks.
• Stapled hemorrhoidectomy: This is the preferred option for prolapsed hemorrhoids where surgical staples block blood flow to the hemorrhoidal veins. Surgery can often be performed under local anesthesia. Recovery time will be shorter.
• Hemorrhoidal artery ligation and anorectal repair (HAL-RAR): This is a newer procedure in which a wand-shaped ultrasound device is inserted into the rectum to pinpoint the blood vessels supplying the hemorrhoid veins. Next, tie these vessels individually. Monitored anesthesia therapy (MAC) can be used to induce “twilight sleep.”

summary

Prolapsed hemorrhoids are internal hemorrhoids that prolapse outside the rectum.

Common symptoms include a painless lump in the anus, itching or irritation, mucus production, and bright red rectal bleeding. Severely prolapsed hemorrhoids are at risk for painful complications such as clotting of the hemorrhoidal veins and reduced blood flow.

Treatment for prolapsed hemorrhoids depends on their severity. It may include self-care strategies, medications, professional treatment, or surgery.

A word from Berrywell

A healthy lifestyle can help prevent hemorrhoids from developing in the first place. This is especially true if you are older and more prone to constipation.

Small changes in diet and physical activity can make a big difference between having hemorrhoids and not having them.