Hemorrhoids are a common condition involving swollen veins in the rectum or around the anus. These normal anatomical structures, known as anal cushions, can become enlarged and irritated under pressure. A specific concern arises when these internal structures protrude from the anal opening.
Defining Prolapsed Hemorrhoids
A prolapsed hemorrhoid occurs when an internal hemorrhoid, which normally resides within the rectum, swells and pushes outward through the anal opening. This protrusion often presents as a soft, visible lump or bulge around the anus. Unlike external hemorrhoids, which are outside the anus, a prolapsed hemorrhoid is an internal one that has moved from its usual position.
Individuals experiencing a prolapsed hemorrhoid may feel various sensations, including discomfort, itching, or a feeling of fullness in the anal region. Pain can also be present, especially during bowel movements or when sitting. Sometimes, bright red blood might appear on toilet paper or in the toilet bowl.
Levels of Prolapse
The severity of internal hemorrhoid prolapse is categorized into four grades. Grade I hemorrhoids do not prolapse outside the anus, though they may bleed.
Grade II hemorrhoids protrude from the anal opening during straining but spontaneously retract back inside afterward. For Grade III hemorrhoids, the prolapse extends outside the anus and does not retract on its own; manual assistance is needed to push them back inside. Grade IV hemorrhoids are permanently prolapsed and cannot be manually reinserted into the anal canal.
Common Contributing Factors
Increased pressure within the veins of the lower rectum and anus is a primary reason for hemorrhoid development and prolapse. Straining during bowel movements is a frequent cause, often linked to chronic constipation or prolonged periods spent on the toilet. This sustained pressure can weaken the supporting tissues that hold internal hemorrhoids in place.
Other factors also contribute to this increased pressure. Pregnancy places additional stress on pelvic blood vessels due to the growing uterus. Heavy lifting, obesity, and a diet consistently low in fiber can elevate abdominal pressure. These factors make anal cushions more susceptible to swelling and protrusion.
Initial Steps for Relief
Managing discomfort often begins with practical measures at home. Increasing dietary fiber intake helps soften stools, making them easier to pass and reducing straining. Adequate hydration supports softer stool consistency.
Warm sitz baths offer relief by relaxing the anal muscles and improving blood flow to the affected area. Soaking for 10 to 15 minutes a few times a day can help alleviate pain and irritation. Practicing good anal hygiene and using over-the-counter topical treatments, such as creams containing witch hazel or hydrocortisone, can temporarily reduce swelling and itching.
When Medical Consultation is Necessary
While many prolapsed hemorrhoids improve with home care, certain signs indicate medical evaluation is appropriate. Persistent or severe pain that does not respond to home remedies warrants medical attention. Significant or continuous bleeding, especially if the blood is bright red, should also prompt consultation, as other conditions can cause similar symptoms.
Changes in bowel habits, such as new onset constipation or diarrhea, or a feeling of incomplete bowel evacuation, suggest medical advice. Signs of infection, like fever or pus, or if a prolapsed hemorrhoid cannot be manually reduced, also warrant prompt medical attention. A healthcare professional can provide an accurate diagnosis and recommend suitable management strategies.