Hemorrhoids are swollen veins in the rectum or anus. They can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). Many individuals experience symptoms like pain, itching, irritation, and bleeding. A common question is whether a prolapsed hemorrhoid can be manually pushed back into place.
Understanding Prolapsed Hemorrhoids
Hemorrhoids become “prolapsed” when internal hemorrhoids push outside the anal opening. This happens when supporting tissues weaken, often due to increased pressure from straining during bowel movements, chronic constipation, or prolonged sitting. Prolapsed hemorrhoids are categorized into different grades based on their severity:
Grade I: May bleed but do not protrude outside the anus.
Grade II: Prolapse during straining but spontaneously retract back inside afterwards.
Grade III: Prolapse and do not go back in on their own, requiring manual pushing to return them inside the anal canal.
Grade IV: Permanently prolapsed and cannot be pushed back in.
Is Manual Reduction Possible and Safe?
For some types of prolapsed hemorrhoids, specifically Grade II and Grade III internal hemorrhoids, manual reduction is possible. Grade II hemorrhoids often retract on their own, but gentle assistance can help. Grade III hemorrhoids require manual intervention. Gently pushing a prolapsed hemorrhoid back in is generally safe and can help protect the blood vessel, reducing complications.
However, caution is necessary when attempting manual reduction. The area is delicate, and improper or forceful attempts can cause pain, discomfort, or injury, such as tearing or worsening swelling. Do not attempt manual reduction if there is severe pain, significant bleeding, or signs of a blood clot (thrombosis), which appears as a bluish-purple, painful lump.
When to Seek Medical Attention
If you experience persistent pain, significant bleeding, or if home remedies do not provide relief within about a week, consult a healthcare provider. Large amounts of bright red blood on toilet paper, in the toilet bowl, or on the stool itself should prompt medical evaluation, as it could indicate other conditions. Other concerning symptoms include worsening pain, a hemorrhoid that becomes hard and discolored, or signs of infection such as fever, chills, or pus discharge. A hemorrhoid that becomes thrombosed, meaning a blood clot forms inside it, can cause severe pain and requires medical attention. If a prolapsed hemorrhoid cannot be pushed back in or if it becomes trapped and painful, potentially cutting off its blood supply (strangulated hemorrhoid), urgent medical care is necessary.
Alternative Management and Prevention
Beyond manual reduction, non-manual approaches can help manage hemorrhoids and prevent recurrence. Lifestyle modifications are often the first line of defense. Eating a diet rich in fiber from fruits, vegetables, and whole grains, along with adequate hydration, helps soften stools and prevents straining during bowel movements. Avoiding prolonged sitting, especially on the toilet, and engaging in regular exercise can also reduce pressure on the rectal veins.
Over-the-counter treatments provide symptomatic relief, including creams, ointments, and suppositories with ingredients like hydrocortisone for inflammation and itching, or witch hazel and lidocaine for pain. Sitz baths, soaking the anal area in warm water, also alleviate discomfort. For persistent or severe cases, a doctor might recommend medical procedures such as rubber band ligation, sclerotherapy, or infrared coagulation, performed in an office setting. Surgical options like hemorrhoidectomy are considered for larger or more complex cases.