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Prolapsed Hemorrhoids - Symptoms, Causes, and Treatment

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A hemorrhoid that protrudes out from the anus is called a prolapsed hemorrhoid.

Medically reviewed by

Dr. Shivpal Saini

Published At April 13, 2023
Reviewed AtApril 19, 2023

Introduction

When the veins in the rectum become swollen, the condition is called hemorrhoids. The last portion of the large intestine before the anus is called the rectum. When the swollen veins protrude from the anus, the condition is called prolapsed hemorrhoids. The end portion of the intestine, where it exits the body, is called the anus. Prolapsed hemorrhoids may be a very painful condition for some people. It is different from external hemorrhoids (which occur outside the anus) and internal hemorrhoids (which occur inside the rectum).

What Are Prolapsed Hemorrhoids?

When the veins in the anus become swollen and protrude outside, the condition is called prolapsed hemorrhoids. There are two types of hemorrhoids, depending on their location: external hemorrhoids, which occur outside the anus, and internal hemorrhoids, which occur in the rectum. They can cause bleeding, itching, and discomfort, especially while sitting down or passing bowels. Prolapse hemorrhoids are usually not complicated, but the severe ones may burst, form clots, or get trapped in the anal muscles. In most cases, prolapse hemorrhoids resolve on their own with some home remedies. The more severe ones that do not resolve may require medications or even surgery.

What Are the Symptoms of Prolapsed Hemorrhoids?

The common symptoms of prolapse hemorrhoids:

  • Presence of lumps in the anus; which can be felt by wiping a hand over the area. These lumps are enlarged veins, which can be painful or painless.

  • The skin over the anus may be irritated

  • Blood in the toilet, which is bright red and highly fluid (bleeding from the stomach or the intestines is usually tarry, black, or dark in color)

  • Hemorrhoids that are big can cause great discomfort especially while sitting down and during bowel movements. They can also create a feeling of incomplete bowel evacuation.

  • Itching in the anal region is common in prolapse hemorrhoids. The skin in the region may be exposed and irritated.

  • There can be white mucous discharge that occurs as a result of rectal inflammation.

  • The mucus can be foul-smelling.

  • A feeling of incomplete evacuation (the sensation that the bowels are still full even after bowel movements).

  • Fecal leakage as the tissues are prolapsed.

What Are the Causes of Prolapsed Hemorrhoids?

When the tissue that holds a hemorrhoid becomes weak, it can prolapse. There can be many factors causing the tissue to become weak.

  • Constant Strain: Straining constantly during bowel movements can weaken the connective tissue. This can be seen in constipation or in diarrhea.

  • Pregnancy: Pregnancy also increases the risk of hemorrhoid prolapse. Forty percent of pregnant women are found to have hemorrhoids and if left untreated, can prolapse.

  • Obesity: Obesity can be another risk factor. The extra weight puts more strain on the rectal muscles. This can lead to hemorrhoids, and prolapse of these internal and external hemorrhoids.

  • Smoking: Cigarette smoking can increase the risk of hemorrhoids and prolapse hemorrhoids.

  • Inherited: A family history of hemorrhoids increases the risk of prolapse hemorrhoids.

  • Constipation: Constant czsonstipation can increase the risk of prolapse hemorrhoids.

What Are the Risk Factors for Prolapsed Hemorrhoids?

The risk factors for prolapsed hemorrhoids include:

  • Older age.

  • Chronic constipation.

  • Chronic diarrhea.

  • A high fat, low fiber diet.

  • Lack of physical activity.

  • Obesity.

  • Over-use of anti-emetics.

  • Pregnancy.

What Are the Complications of Prolapsed Hemorrhoids?

If you don't treat prolapsed hemorrhoids, they can get very swollen and stop you from going to the bathroom. They can also cause bleeding. If the hemorrhoid is large and an underlying vessel breaks, it can cause severe blood loss and result in dizziness, fainting, and, in rare cases, shock and even death. Other complications may include:

  • Venous Thrombosis: When a blood clot is formed in the hemorrhoidal vein, the condition is called venous thrombosis. It causes obstruction of the blood flow and results in swelling of the tissues, which can be painful.

  • Incarceration: When the hemorrhoid is stuck in between the tissues of the anus, the condition is called incarceration.

  • Strangulation: When the hemorrhoid is devoid of proper blood supply, it is called strangulation. It can lead to severe pain, tissue death, and gangrene (gangrene is the death of a tissue due to a lack of blood supply or infection).

How Are Prolapsed Hemorrhoids Diagnosed?

A prolapsed hemorrhoid is visible during a physical examination. Digital examination may be used to find out the grade of the hemorrhoid. Internal hemorrhoids are of four stages:

  • Grade 1: They are prominent, but do not protrude into the anal canal. Bleeding may be present.

  • Grade 2: They protrude out to the anal canal during bowel movements, but go back on their own.

  • Grade 3: They protrude out during a bowel movement, and have to be put back manually.

  • Grade 4: They protrude out from the anal canal, and cannot be put back in. This can be painful and has a high risk of strangulation.

How Are Prolapsed Hemorrhoids Managed?

Some home remedies can help to treat the condition in the initial stages. They include:

  • Suppositories and Ointments: Over-the-counter hemorrhoid products can be used like suppositories and ointments.

  • High Fiber Diet: Have a diet high in fiber, and drink ample amounts of water to soften the stool, to prevent straining during bowel movements.

  • Sitz Bath: Soak the perineal area in a warm bath for some time.

  • Warm Wipes: Use warm damp wipes after bowel movements. This should not contain any alcohol content which may irritate the tissues.

  • Cold Packs: Ice packs can be used around the hemorrhoids to reduce swelling.

  • Gentle Exercise: Gentle exercise done regularly can help to prevent constipation.

What Are the Treatments for Severe Prolapsed Hemorrhoids?

When the home remedies are not able to manage the condition, it requires medical attention. The treatment will depend on the type and grade of hemorrhoid. Lesser than ten percent of hemorrhoids are treated surgically. There are other minimally invasive procedures that might help to resolve the condition.

  1. Rubber Band Ligation: A band is tied to the hemorrhoid, which reduces its blood flow and causes it to shrink.

  2. Sclerotherapy: Chemicals that shrink the blood vessels are injected into hemorrhoids.

  3. Coagulation: A laser beam, infrared, or heat is used to coagulate the hemorrhoid, which then hardens and dissolves.

Conclusion

If these are not sufficient to manage the hemorrhoids, surgery would be required. External hemorrhoids with a clot can be managed with hemorrhoid thrombectomy. This involves removing hemorrhoids and draining the wound. Hemorrhoidectomy is done for more severe hemorrhoids. All the hemorrhoid tissues are removed in this procedure.

Introduction

When the veins in the rectum become swollen, the condition is called hemorrhoids. The last portion of the large intestine before the anus is called the rectum. When the swollen veins protrude from the anus, the condition is called prolapsed hemorrhoids. The end portion of the intestine, where it exits the body, is called the anus. Prolapsed hemorrhoids may be a very painful condition for some people. It is different from external hemorrhoids (which occur outside the anus) and internal hemorrhoids (which occur inside the rectum).

What Are Prolapsed Hemorrhoids?

When the veins in the anus become swollen and protrude outside, the condition is called prolapsed hemorrhoids. There are two types of hemorrhoids, depending on their location: external hemorrhoids, which occur outside the anus, and internal hemorrhoids, which occur in the rectum. They can cause bleeding, itching, and discomfort, especially while sitting down or passing bowels. Prolapse hemorrhoids are usually not complicated, but the severe ones may burst, form clots, or get trapped in the anal muscles. In most cases, prolapse hemorrhoids resolve on their own with some home remedies. The more severe ones that do not resolve may require medications or even surgery.

What Are the Symptoms of Prolapsed Hemorrhoids?

The common symptoms of prolapse hemorrhoids:

  • Presence of lumps in the anus; which can be felt by wiping a hand over the area. These lumps are enlarged veins, which can be painful or painless.

  • The skin over the anus may be irritated

  • Blood in the toilet, which is bright red and highly fluid (bleeding from the stomach or the intestines is usually tarry, black, or dark in color)

  • Hemorrhoids that are big can cause great discomfort especially while sitting down and during bowel movements. They can also create a feeling of incomplete bowel evacuation.

  • Itching in the anal region is common in prolapse hemorrhoids. The skin in the region may be exposed and irritated.

  • There can be white mucous discharge that occurs as a result of rectal inflammation.

  • The mucus can be foul-smelling.

  • A feeling of incomplete evacuation (the sensation that the bowels are still full even after bowel movements).

  • Fecal leakage as the tissues are prolapsed.

What Are the Causes of Prolapsed Hemorrhoids?

When the tissue that holds a hemorrhoid becomes weak, it can prolapse. There can be many factors causing the tissue to become weak.

  • Constant Strain: Straining constantly during bowel movements can weaken the connective tissue. This can be seen in constipation or in diarrhea.

  • Pregnancy: Pregnancy also increases the risk of hemorrhoid prolapse. Forty percent of pregnant women are found to have hemorrhoids and if left untreated, can prolapse.

  • Obesity: Obesity can be another risk factor. The extra weight puts more strain on the rectal muscles. This can lead to hemorrhoids, and prolapse of these internal and external hemorrhoids.

  • Smoking: Cigarette smoking can increase the risk of hemorrhoids and prolapse hemorrhoids.

  • Inherited: A family history of hemorrhoids increases the risk of prolapse hemorrhoids.

  • Constipation: Constant czsonstipation can increase the risk of prolapse hemorrhoids.

What Are the Risk Factors for Prolapsed Hemorrhoids?

The risk factors for prolapsed hemorrhoids include:

  • Older age.

  • Chronic constipation.

  • Chronic diarrhea.

  • A high fat, low fiber diet.

  • Lack of physical activity.

  • Obesity.

  • Over-use of anti-emetics.

  • Pregnancy.

What Are the Complications of Prolapsed Hemorrhoids?

If you don't treat prolapsed hemorrhoids, they can get very swollen and stop you from going to the bathroom. They can also cause bleeding. If the hemorrhoid is large and an underlying vessel breaks, it can cause severe blood loss and result in dizziness, fainting, and, in rare cases, shock and even death. Other complications may include:

  • Venous Thrombosis: When a blood clot is formed in the hemorrhoidal vein, the condition is called venous thrombosis. It causes obstruction of the blood flow and results in swelling of the tissues, which can be painful.

  • Incarceration: When the hemorrhoid is stuck in between the tissues of the anus, the condition is called incarceration.

  • Strangulation: When the hemorrhoid is devoid of proper blood supply, it is called strangulation. It can lead to severe pain, tissue death, and gangrene (gangrene is the death of a tissue due to a lack of blood supply or infection).

How Are Prolapsed Hemorrhoids Diagnosed?

A prolapsed hemorrhoid is visible during a physical examination. Digital examination may be used to find out the grade of the hemorrhoid. Internal hemorrhoids are of four stages:

  • Grade 1: They are prominent, but do not protrude into the anal canal. Bleeding may be present.

  • Grade 2: They protrude out to the anal canal during bowel movements, but go back on their own.

  • Grade 3: They protrude out during a bowel movement, and have to be put back manually.

  • Grade 4: They protrude out from the anal canal, and cannot be put back in. This can be painful and has a high risk of strangulation.

How Are Prolapsed Hemorrhoids Managed?

Some home remedies can help to treat the condition in the initial stages. They include:

  • Suppositories and Ointments: Over-the-counter hemorrhoid products can be used like suppositories and ointments.

  • High Fiber Diet: Have a diet high in fiber, and drink ample amounts of water to soften the stool, to prevent straining during bowel movements.

  • Sitz Bath: Soak the perineal area in a warm bath for some time.

  • Warm Wipes: Use warm damp wipes after bowel movements. This should not contain any alcohol content which may irritate the tissues.

  • Cold Packs: Ice packs can be used around the hemorrhoids to reduce swelling.

  • Gentle Exercise: Gentle exercise done regularly can help to prevent constipation.

What Are the Treatments for Severe Prolapsed Hemorrhoids?

When the home remedies are not able to manage the condition, it requires medical attention. The treatment will depend on the type and grade of hemorrhoid. Lesser than ten percent of hemorrhoids are treated surgically. There are other minimally invasive procedures that might help to resolve the condition.

  1. Rubber Band Ligation: A band is tied to the hemorrhoid, which reduces its blood flow and causes it to shrink.

  2. Sclerotherapy: Chemicals that shrink the blood vessels are injected into hemorrhoids.

  3. Coagulation: A laser beam, infrared, or heat is used to coagulate the hemorrhoid, which then hardens and dissolves.

Conclusion

If these are not sufficient to manage the hemorrhoids, surgery would be required. External hemorrhoids with a clot can be managed with hemorrhoid thrombectomy. This involves removing hemorrhoids and draining the wound. Hemorrhoidectomy is done for more severe hemorrhoids. All the hemorrhoid tissues are removed in this procedure.

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Dr. Shivpal Saini
Dr. Shivpal Saini

General Surgery

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