Hemorrhoids are swollen veins in the rectum or anus, affecting roughly half of all adults by age 50. The concern about “pushing them back in” relates to hemorrhoids that have slipped outside of their normal position within the anal canal. Understanding the nature and severity of the hemorrhoid is the first step in determining if manual reduction is a safe and appropriate action. A persistent bulge outside the anus may indicate a more advanced stage requiring careful management.
Identifying Prolapsed Hemorrhoids
The ability to manually reduce a hemorrhoid depends on its classification, based on the degree of prolapse outside the anal opening. Internal hemorrhoids, originating above the dentate line, are categorized into four grades based on severity. External hemorrhoids form below this line, are covered by sensitive skin, and cannot typically be pushed back inside.
Grade I hemorrhoids do not prolapse, though they may cause painless bleeding. Grade II hemorrhoids prolapse outside the anal canal during straining, such as during a bowel movement, but they spontaneously retract afterward. Manual reduction primarily concerns Grade III internal hemorrhoids, which protrude outside the anus but require physical effort to be returned to their normal position.
Grade IV hemorrhoids are the most severe classification because they are permanently prolapsed and cannot be reduced by the individual. This grading system guides treatment, confirming that manual reduction is applicable only to Grade III internal hemorrhoids. The presence of a painful, irreducible lump may indicate a complication requiring different management.
Performing Manual Reduction
Manual reduction involves gently guiding the prolapsed tissue back into the anal canal, a technique often taught by physicians to patients with Grade III hemorrhoids. Proper preparation is paramount to avoid trauma or infection. Hands should be thoroughly washed with soap and water before beginning the process.
Applying a generous amount of a water-soluble lubricant or a topical anesthetic, such as lidocaine gel, to the prolapsed tissue can ease the process and reduce pain. The person should find a comfortable, relaxed position, such as lying on their side or standing with one foot elevated. This positioning helps relax the anal sphincter muscles, which aids in successful reduction.
Using the lubricated pad of a finger, gentle, steady pressure should be applied to the hemorrhoid, pushing it slowly back through the anal opening. The pressure must be directed inward and slightly upward, following the natural curve of the anal canal. If any sharp or escalating pain occurs, stop the attempt immediately to avoid damaging the tissue.
Once the hemorrhoid is successfully reduced, remain lying down briefly to help the tissue stay in place. Applying a cold compress or a witch hazel pad afterward can reduce residual swelling and discomfort. Maintaining soft stool consistency through increased fiber and fluid intake is an important part of post-reduction care to prevent immediate re-prolapse.
Signs of Failure and Complications
Manual reduction may fail if the hemorrhoid is significantly swollen or if it is a Grade IV hemorrhoid, which is permanently prolapsed and irreducible. Failure to reduce the tissue after a careful attempt, or immediate re-prolapse, signals the need for professional medical evaluation. A medical professional can assess the swelling and may use specialized techniques or osmotic agents, such as sugar, to draw fluid out of the tissue and facilitate reduction.
A serious complication of irreducible prolapse is strangulation, where the anal sphincter muscle traps the hemorrhoid, cutting off its blood supply. This condition presents with sudden, severe, and escalating pain, often disproportionate to the lump’s size. The trapped hemorrhoidal tissue may appear dark red, purple, or black due to lack of adequate blood flow.
Other signs requiring immediate medical attention include significant, ongoing rectal bleeding, especially if the toilet water turns red or large clots are passed. Severe pain that makes sitting or walking difficult, or any sign of infection like fever, should prompt an urgent consultation. If manual reduction is repeatedly necessary or causes persistent pain, a doctor may recommend non-surgical procedures like rubber band ligation or sclerotherapy.