Hemorrhoids are swollen veins located in the rectum or anus. When internal hemorrhoids enlarge and push outside the anal opening, they are referred to as prolapsed hemorrhoids.
Understanding Prolapsed Hemorrhoids
Prolapsed hemorrhoids occur when internal tissues descend and protrude through the anus. This protrusion often results from increased pressure or weakening of anchoring tissues. The severity of prolapse is categorized into four grades, indicating the extent of protrusion and whether they can be manually pushed back inside.
Grade I hemorrhoids remain internal and do not prolapse outside the anus, though they may bleed. Grade II hemorrhoids prolapse during a bowel movement or straining but spontaneously retract back inside afterwards. Grade III hemorrhoids prolapse outside the anus and require manual repositioning by the individual. Grade IV hemorrhoids are permanently prolapsed, remaining outside the anus and cannot be pushed back in, representing the most severe form.
Recognizing the Signs
Individuals experiencing prolapsed hemorrhoids may notice a soft lump or bulge protruding from the anus, felt during wiping or after a bowel movement. This protrusion can cause a sensation of fullness or discomfort in the anal area. Itching around the anus is a common symptom, resulting from irritation caused by the prolapsed tissue or mucus discharge.
Pain levels can vary, ranging from mild discomfort in lower grades to significant pain, especially with Grade III or IV prolapse. Bright red blood may be observed on toilet paper, in the toilet bowl, or on the surface of stool, indicating bleeding from the irritated blood vessels. Mucus discharge from the anus is also possible, contributing to anal irritation and itching.
Common Causes and Risk Factors
Prolapsed hemorrhoids develop due to increased pressure in the veins around the anus, which can stretch and weaken supporting tissues. Chronic constipation is a frequent cause, as prolonged straining during bowel movements elevates pressure within the abdominal and pelvic regions. Chronic diarrhea can also contribute by increasing bowel movements and irritation.
Extended periods of sitting on the toilet can also lead to increased pressure on the anal veins, contributing to their enlargement and descent. Pregnancy often predisposes individuals to hemorrhoids due to increased abdominal pressure from the growing uterus and hormonal changes that relax supporting tissues. Obesity and heavy lifting can also raise intra-abdominal pressure, increasing the risk of developing or worsening hemorrhoids. A diet low in fiber can lead to harder stools, necessitating more straining during defecation.
Approaches to Treatment
Treatment for prolapsed hemorrhoids begins with conservative lifestyle modifications aimed at reducing straining and softening stools. Increasing dietary fiber intake through fruits, vegetables, and whole grains, along with adequate hydration, helps promote regular, soft bowel movements. Avoiding prolonged sitting on the toilet and responding promptly to the urge to defecate can also alleviate pressure.
Over-the-counter remedies, such as creams containing witch hazel or hydrocortisone, and suppositories can provide temporary relief from itching, swelling, and discomfort. These topical treatments help soothe the irritated area and reduce inflammation. For persistent or higher-grade prolapse, office-based procedures may be recommended.
Rubber band ligation involves placing a small elastic band around the base of the internal hemorrhoid, cutting off its blood supply, causing it to wither and fall off within a week. Sclerotherapy involves injecting a solution into the hemorrhoid to shrink it, while infrared coagulation uses heat to clot the blood within the hemorrhoid, causing it to retract. For severe or unresponsive cases, surgical options like hemorrhoidectomy may be considered.
When to Seek Medical Advice
It is advisable to consult a healthcare professional if you experience persistent symptoms of prolapsed hemorrhoids that do not improve with self-care measures. Severe pain, significant or continuous bright red bleeding, or any changes in bowel habits, such as unexplained constipation or diarrhea, warrant medical evaluation. A medical professional can accurately diagnose the condition and rule out other more serious causes of bleeding or discomfort.