Hemorrhoids, also known as piles, are swollen veins in the lower rectum and anus, similar to varicose veins. They can cause discomfort, itching, and bleeding. About half of all adults experience hemorrhoids by age 50. This article explores prolapsed hemorrhoids and the considerations for their manual reduction.
What is a Prolapsed Hemorrhoid?
Hemorrhoids develop from anal cushions, normal vascular structures in the anal canal that aid in stool control. They form when these cushions swell due to increased pressure on the veins. Hemorrhoids are categorized as internal (inside the rectum) or external (under the skin around the anus). Internal hemorrhoids are usually not visible or felt and often cause painless bleeding.
A prolapsed hemorrhoid occurs when an internal hemorrhoid enlarges and protrudes outside the anal opening. This bulging often results from increased pressure in the anal or rectal area, such as from straining during bowel movements, chronic constipation or diarrhea, prolonged sitting, or pregnancy. The connective tissue holding the hemorrhoid weakens, allowing it to slip out. Prolapsed hemorrhoids vary in severity, from those that retract on their own to those that permanently remain outside the anus.
Attempting Manual Reduction
Gently pushing a prolapsed internal hemorrhoid back into the anus, known as manual reduction, can be an option, especially for Grade 3 prolapse where it protrudes but can be reinserted. Before attempting this, ensure proper hygiene by washing hands thoroughly with soap and warm water. Lying down in a comfortable position, such as on your side, can facilitate the process. Applying a small amount of lubricating jelly or a topical hemorrhoid cream to the prolapsed tissue may help.
With gentle, steady pressure, the hemorrhoid can be slowly pushed back inside the anal canal. Avoid excessive force, which could cause further irritation or injury. After successful reduction, remain lying down for a short period to help the hemorrhoid stay in place. While manual reduction offers temporary relief from discomfort and pain, it does not address the underlying cause of the prolapse and is not a permanent cure.
However, manual reduction is not always advisable. If the hemorrhoid is severely painful, firm, discolored (blueish), or accompanied by significant bleeding, it may indicate a thrombosed hemorrhoid (a blood clot within the hemorrhoid) or other complications. Attempting manual reduction in such instances could worsen the condition or cause intense pain. If there is any uncertainty about the nature of the hemorrhoid or if the attempt causes increased pain, it is important to stop and seek professional medical advice.
When to Seek Professional Medical Care
While many hemorrhoids can be managed with home remedies, certain symptoms require a visit to a healthcare provider. Any rectal bleeding, especially if heavy, persistent, or accompanied by dizziness or faintness, warrants immediate medical attention to rule out more serious conditions. Though hemorrhoids commonly cause bright red blood on toilet paper or in the toilet bowl, bleeding can also signal other digestive disorders, including colorectal cancer.
If hemorrhoid symptoms like pain, discomfort, or itching do not improve after a week of consistent home treatment, or if they worsen, consult a doctor. A healthcare professional can accurately diagnose the condition and recommend appropriate treatment. If you notice a lump around the anus that cannot be gently pushed back in, or if there are signs of infection like fever or pus, medical evaluation is important. Changes in bowel habits, unexplained weight loss, or dark, tarry stools also require prompt medical assessment.
Beyond Manual Reduction: Other Approaches
Managing hemorrhoids effectively often involves lifestyle modifications and over-the-counter (OTC) remedies. Increasing dietary fiber by consuming more fruits, vegetables, and whole grains helps soften stools, making them easier to pass and reducing straining. Drinking plenty of water (6 to 8 glasses daily) also contributes to softer stools and helps prevent constipation.
Avoiding prolonged sitting, especially on the toilet, and going to the bathroom as soon as the urge arises can prevent added pressure on the anal veins. Regular, moderate exercise promotes healthy bowel movements and overall digestive health. For symptomatic relief, warm sitz baths (soaking the affected area in warm water for 10-15 minutes multiple times a day) can soothe pain and itching. OTC topical creams with ingredients like hydrocortisone, witch hazel, or lidocaine can reduce inflammation, itching, and discomfort. Oral pain relievers like acetaminophen or ibuprofen can also help manage discomfort.