Hemorrhoids are a common condition involving swollen veins in the lower rectum and anus. When an internal hemorrhoid enlarges and pushes outside the anal opening, it is described as prolapsed. This protrusion often causes discomfort, itching, and sometimes bleeding. Whether a prolapsed hemorrhoid resolves on its own depends entirely on its severity.
Understanding Prolapsed Hemorrhoids
Prolapsed internal hemorrhoids are classified using a grading system that dictates the degree of protrusion and the required type of management. Grade I hemorrhoids do not prolapse outside the anal canal but may bleed. A true prolapse begins with Grade II, where the hemorrhoid protrudes during a bowel movement or straining but then spontaneously retracts back inside the anus afterward.
Grade III hemorrhoids protrude beyond the anal opening and do not retract automatically, instead requiring a person to manually push them back into the anal canal. The most severe type is Grade IV, which involves hemorrhoids that are permanently prolapsed and cannot be manually pushed back inside. The distinction between a “reducible” prolapse (Grades II and III) and a “non-reducible” prolapse (Grade IV) is a major factor in determining the likelihood of natural resolution.
The Likelihood of Natural Resolution
The ability of a prolapsed hemorrhoid to resolve without intervention is directly tied to its grade. Grade II hemorrhoids, which spontaneously retract, often respond well to conservative treatments and may shrink back entirely as swelling decreases. Many internal hemorrhoids that are mildly prolapsed may go away with only at-home care, as the symptoms subside.
However, the natural resolution rate drops significantly for more advanced stages. Grade III hemorrhoids, while still reducible with manual help, are much less likely to resolve completely without some form of medical procedure because the underlying supportive tissue is more significantly damaged. A Grade IV hemorrhoid, which is permanently protruding, is considered irreducible and will not go away on its own. These advanced cases typically require a procedural intervention to be corrected.
For the prolapses that do resolve, improvement is usually noticed within a week of consistent self-care and lifestyle changes. If a Grade II hemorrhoid remains prolapsed or continues to cause significant discomfort beyond this timeframe, professional evaluation is warranted. For any hemorrhoid that requires manual reduction (Grade III) or cannot be reduced at all (Grade IV), intervention beyond home remedies is almost always necessary to provide lasting relief.
Immediate Self-Care and Lifestyle Adjustments
Focusing on softening stool and reducing pressure is the most effective immediate self-care strategy for managing a mild prolapse. Increasing dietary fiber intake, ideally aiming for a fiber supplement like psyllium husk, helps to bulk the stool and make it easier to pass. Adequate hydration is also necessary for the fiber to work effectively and keep the stool soft.
Stool softeners containing docusate sodium can provide additional relief by helping the stool retain water, decreasing the straining needed for a bowel movement. Avoid sitting on the toilet for extended periods, such as reading or using a phone, and resist the urge to strain, as both actions increase pressure on the hemorrhoidal veins. Soaking the anal area in a warm bath or a specialized Sitz bath for 10 to 15 minutes two or three times a day can relieve pain and reduce swelling.
Topical treatments can temporarily soothe symptoms. Over-the-counter creams or suppositories containing hydrocortisone help to reduce inflammation. Pads containing witch hazel, a natural astringent, can be applied to the area to temporarily shrink swollen tissue and relieve minor itching. These self-care measures are designed to relieve symptoms and reduce inflammation, which can promote the spontaneous retraction of Grade II hemorrhoids.
When Professional Medical Intervention Is Required
A doctor’s visit becomes necessary if symptoms persist for more than a week despite consistent home treatment or if the hemorrhoid is clearly advanced. Warning signs include severe or persistent pain, excessive or prolonged rectal bleeding, or a prolapse that suddenly becomes dark and painful, which may indicate a thrombosed hemorrhoid. These signs can suggest complications or other serious conditions, such as colon cancer, which must be ruled out.
For hemorrhoids that do not resolve with conservative care, several in-office procedures are available. For non-resolving Grade III and all Grade IV hemorrhoids, a surgical hemorrhoidectomy, which physically removes the excess tissue, is often the most effective solution.
- Rubber band ligation is a common procedure where a tiny band is placed around the base of the internal hemorrhoid to cut off blood flow, causing it to shrink and fall off within about a week.
- Sclerotherapy involves injecting a chemical solution into the hemorrhoid tissue to cause it to scar and shrink.