Hemorrhoids, also known as piles, are a common condition characterized by swollen veins in the anus and lower rectum. They affect a significant portion of the adult population, with estimates suggesting about half of all people experience them by age 50. The question of whether these can or should be pushed back into place is a common concern.
Understanding Hemorrhoids and Prolapse
Hemorrhoids are categorized into two main types: internal and external. Internal hemorrhoids form inside the rectum, above the dentate line, where pain-sensing nerves are sparse, leading to often painless symptoms. They often present with painless bleeding, typically bright red blood on toilet paper or in the bowl. External hemorrhoids develop under the skin around the anus, below the dentate line, an area rich in pain receptors. They can cause itching, irritation, and significant discomfort.
External hemorrhoids are visible as lumps outside the anus, while internal hemorrhoids are typically not seen or felt unless they protrude. Prolapse occurs when an internal hemorrhoid swells and bulges out through the anal opening, often due to straining during bowel movements. Prolapsed internal hemorrhoids vary in severity; some may retract spontaneously, while others require manual assistance to return inside or may remain permanently outside.
When Manual Reduction Might Be Considered
Manual reduction, the gentle pushing of a prolapsed hemorrhoid back inside, is primarily considered for certain types of internal hemorrhoids, specifically Grade 3 internal hemorrhoids. These prolapse during straining but can be manually returned into the anal canal. The rationale is to protect the blood vessel and potentially reduce the risk of complications like blood clots or strangulation.
If considering manual reduction, it is important to approach it with caution and prioritize hygiene. The area should be thoroughly cleaned, and a lubricant can be used to facilitate the process. The technique involves gently pushing the prolapsed tissue back into the anal opening. However, this should only be attempted if the hemorrhoid is not severely painful, thrombosed (containing a blood clot), or significantly bleeding. This action is not a cure but a temporary measure to alleviate discomfort and prevent further complications.
Risks and Contraindications of Manual Reduction
Attempting manual reduction carries several risks. Pushing a hemorrhoid back can cause injury to the tissues, leading to increased pain, bleeding, or even infection. A significant risk is the development of a blood clot, known as thrombosis, which can cause severe pain and a hard, blue or purple lump.
If a prolapsed hemorrhoid becomes trapped outside the anus by the sphincter muscles, its blood supply can be cut off, leading to a condition called strangulation. This is a painful and serious complication that can result in tissue damage. Manual reduction is contraindicated if there is severe pain, significant bleeding, suspected thrombosis, or if the hemorrhoid cannot be easily or gently reinserted. External hemorrhoids should never be pushed back inside, because they originate outside the anal canal.
When to Seek Medical Attention
While many hemorrhoid symptoms can be managed with home care, certain signs require professional medical evaluation. Persistent pain that does not improve with over-the-counter remedies, or pain that becomes severe, warrants a doctor’s visit. Significant rectal bleeding, especially if the toilet water turns red or large blood clots are present, requires immediate medical attention.
Any new or worsening symptoms, such as a prolapsed hemorrhoid that cannot be gently pushed back inside, or signs of infection like fever, pus, or increased swelling, should prompt medical consultation. It is important to seek professional diagnosis if there is uncertainty about whether symptoms are due to hemorrhoids or a more serious condition, such as colorectal cancer or anal fissures.
Alternative Management and Prevention
Beyond manual reduction, a range of strategies can help manage hemorrhoid symptoms and prevent recurrence. Increasing dietary fiber intake to 25-35 grams daily, through fruits, vegetables, and whole grains, can soften stools and reduce straining during bowel movements. Adequate hydration by drinking plenty of water also contributes to softer stools.
Sitz baths, involving soaking the anal area in warm water for 15-20 minutes several times a day, can relieve pain and itching. Over-the-counter topical creams containing ingredients like witch hazel or hydrocortisone can provide temporary relief from discomfort. Lifestyle adjustments, such as avoiding prolonged sitting, especially on the toilet, and incorporating regular, moderate exercise, can also help reduce pressure on the rectal veins and promote healthy bowel function. For persistent or severe cases, non-surgical office procedures like rubber band ligation or sclerotherapy may be recommended by a medical professional.