Hemorrhoids are swollen veins located in the rectum or around the anus. Sometimes, internal hemorrhoids can enlarge and protrude outside the anus, a condition known as prolapse. This article will guide you through understanding and managing a prolapsed hemorrhoid by manually reinserting it.
Understanding Prolapsed Hemorrhoids
Hemorrhoids are categorized into internal and external types based on their location. Internal hemorrhoids form inside the rectum and are not visible or felt unless they prolapse, while external hemorrhoids develop under the skin around the anus and are often visible and palpable. Prolapse occurs when internal hemorrhoids, due to increased pressure, swell and push outward from the anal canal.
Common factors contributing to prolapse include chronic constipation, prolonged straining during bowel movements, extended periods of sitting on the toilet, and conditions like pregnancy or obesity. When internal hemorrhoids prolapse, they are graded on a scale from 1 to 4, with Grade 3 hemorrhoids requiring manual reinsertion and Grade 4 hemorrhoids being permanently prolapsed and unable to be pushed back in.
When Manual Reduction is Appropriate
Manual reduction is suitable for internal hemorrhoids that have prolapsed, specifically Grade 3 hemorrhoids, which protrude but can be pushed back inside. This method is appropriate for mild discomfort, no severe pain, and minimal bleeding. It can reduce the risk of complications such as blood clots or strangulation.
However, there are situations when manual reduction should not be attempted. If you experience severe pain, significant or persistent bleeding, or if the hemorrhoid appears hard, bluish, or extremely painful, do not attempt to push it back. These symptoms could indicate a thrombosed hemorrhoid (a blood clot within the hemorrhoid) or strangulation (when the blood supply is cut off), both serious conditions. External hemorrhoids, which are already outside the anus, should also not be pushed back in.
Step-by-Step Guide to Manual Reduction
Before attempting manual reduction, ensure your hands are thoroughly washed with soap and water; disposable gloves are an option for hygiene. Find a comfortable position, such as squatting or lying on your side, for easier access and anal muscle relaxation. Applying a small amount of lubricant, like petroleum jelly or a topical anesthetic gel, to the hemorrhoid and anal opening facilitates the process and minimizes discomfort.
Gently apply steady, firm pressure to the prolapsed hemorrhoid with a lubricated finger, pushing it upward and inward into the anal canal. Fully reinsert the tissue so it is no longer visible or palpable externally. Once reinserted, maintain the position briefly, perhaps by lying down for 10 to 15 minutes, to help the hemorrhoid remain inside. After the procedure, avoid straining during bowel movements and consider incorporating a high-fiber diet and increased fluid intake to soften stools.
When to Seek Medical Attention
While self-care can be effective for many hemorrhoids, certain signs indicate professional medical attention is needed. If manual reduction attempts are unsuccessful, or if you experience severe or increasing pain, persistent bleeding, or signs of infection (fever or pus), consult a healthcare provider. Also seek medical attention if a hemorrhoid becomes hard, discolored (blue or black), or intensely painful.
Recurrent prolapse, or any uncertainty about the nature of the lump or your symptoms, also warrants a medical evaluation. A doctor can diagnose the condition and rule out other serious causes of rectal bleeding, such as colorectal cancer. Medical treatments for hemorrhoids range from office-based procedures like rubber band ligation to surgical removal in more severe or persistent cases. Preventative measures, including a high-fiber diet, adequate hydration, and avoiding straining during bowel movements, are recommended to reduce recurrence.