Hemorrhoids are cushions of vascular tissue that naturally exist inside the anal canal. When these cushions become swollen and descend outside the anal opening, the condition is called a prolapsed hemorrhoid. The ability to manually reposition this tissue depends entirely on the degree of the prolapse and the specific type of hemorrhoid involved.
Knowing Which Hemorrhoids Can Be Pushed Back
Hemorrhoids are categorized by location and protrusion, which determines if manual reduction is appropriate. Internal hemorrhoids originate above the dentate line, a region with fewer pain-sensing nerves. They are classified into four grades, but only Grade III is a candidate for manual reduction. Grade III internal hemorrhoids prolapse outside the anus, typically during a bowel movement, and require a finger to be gently pushed back inside the anal canal.
Grade I and II internal hemorrhoids do not require manual intervention because they either do not prolapse or reduce spontaneously. Conversely, Grade IV internal hemorrhoids are permanently prolapsed and cannot be manually reduced, often causing significant discomfort. Attempting to force a Grade IV hemorrhoid back inside is ineffective and may cause additional pain or injury. External hemorrhoids form below the dentate line and are covered by pain-sensitive skin, meaning they should not be pushed back in.
External hemorrhoids are usually painful if they become thrombosed, meaning a blood clot has formed inside the swollen vein. Trying to push a thrombosed external hemorrhoid back into the anal canal is highly painful and should be avoided, as it can worsen inflammation. Therefore, manual reduction is reserved almost exclusively for Grade III internal hemorrhoids.
Performing Manual Reduction Safely
If you have confirmed a Grade III internal hemorrhoid prolapse, manual reduction must prioritize hygiene and gentleness to prevent trauma or infection. Begin by thoroughly washing your hands with soap and warm water, paying close attention to cleaning under your fingernails. This minimizes the risk of introducing bacteria into the sensitive anal tissue. Attempt the reduction only after a bowel movement and after gently cleaning the anal area.
Next, apply generous lubrication to your index finger and the prolapsed tissue, using a sterile lubricant, petroleum jelly, or a topical anesthetic jelly. Proper lubrication is necessary to allow the tissue to slide back easily without friction, preventing tears or further irritation. Positioning your body to relax the anal muscles is also helpful. This can be done by squatting over a toilet or lying on your side with your knees drawn toward your chest.
Using the lubricated finger, apply gentle, sustained pressure directly to the prolapsed tissue. The goal is to slowly guide the hemorrhoid past the anal opening and back inside the anal canal. The pressure should be firm but not painful. If you experience sharp or intense pain, stop immediately, as this suggests the hemorrhoid may be incarcerated or thrombosed. Once repositioned, contract your anal sphincter muscles for a few moments to help keep the hemorrhoid in place.
Recognizing Serious Complications
While manual reduction brings immediate relief for Grade III hemorrhoids, you must know when to stop and seek professional medical help. The most serious complication is strangulation, which occurs when the anal sphincter muscles clamp down on the prolapsed tissue, cutting off its blood supply. A strangulated hemorrhoid will appear dark purple or blue, be intensely painful, and be impossible to push back inside, demanding immediate medical attention.
Inability to reduce the hemorrhoid after several gentle attempts or the presence of sudden, excruciating pain are clear signs to abandon the effort. This resistance may mean the hemorrhoid has progressed to an irreducible Grade IV stage or that a painful thrombosis has occurred. Thrombosed hemorrhoids involve a blood clot and are accompanied by a hard, painful lump that requires evaluation by a healthcare provider.
Persistent or severe bleeding, signs of infection like fever, or pus discharge require prompt medical consultation. Even if reduction is successful, follow up with a doctor if the prolapse recurs frequently. Frequent recurrence indicates a need for more definitive treatment, such as rubber band ligation or surgery. Conservative treatments like warm sitz baths, high-fiber diets, and over-the-counter creams can manage symptoms while awaiting medical consultation.