Hemorrhoids, commonly known as piles, are swollen veins in the lower rectum and anus that can cause discomfort. While internal hemorrhoids typically remain inside the rectum and external hemorrhoids form under the skin around the anus, a prolapsed hemorrhoid occurs when an internal hemorrhoid bulges outside the anal opening. This article will describe the visual characteristics of prolapsed hemorrhoids and outline when to seek medical advice.
Understanding Prolapsed Hemorrhoids
Internal hemorrhoids originate above the dentate line, a boundary within the anal canal, and usually do not cause pain because this area has fewer pain-sensing nerves. Increased pressure in the lower rectum, often from straining during bowel movements, can cause these internal veins to swell and push outward.
Over time, the supporting tissues that hold these hemorrhoids in place can weaken. When this occurs, internal hemorrhoids can descend and bulge out of the anal opening, a process known as prolapse. Unlike external hemorrhoids, which are already located outside the anus, a prolapsed hemorrhoid is an internal structure that has moved externally. This anatomical shift can lead to various noticeable symptoms.
Visual Characteristics by Grade
The appearance of a prolapsed hemorrhoid varies depending on its severity, categorized into four grades. Generally, a prolapsed hemorrhoid can look like a soft, fleshy lump or multiple lumps around the anus. These lumps may appear reddish, pinkish, or even bluish/purplish, especially if there is increased pressure on the blood vessels.
Grade I hemorrhoids are internal and do not prolapse outside the anus, although they may bleed. They are not externally visible but can bulge into the anal canal. Grade II hemorrhoids protrude through the anus during straining, such as during a bowel movement, but then spontaneously retract back inside on their own.
Grade III hemorrhoids prolapse outside the anus during straining or physical activity, but unlike Grade II, they require manual assistance to be pushed back inside. When prolapsed, they appear as a swollen, bumpy mass that can range in size. The tissue may be purple, blue, or red, and it remains outside until manually reduced. Grade IV hemorrhoids are the most advanced, remaining permanently prolapsed outside the anus and cannot be pushed back in. These often present as a large, bulbous mass of protruded anal tissue that is constantly exposed.
Accompanying Signs and Symptoms
Beyond their visual appearance, prolapsed hemorrhoids often present with other noticeable signs and symptoms. A common symptom is the presence of bright red blood, which may be seen on toilet paper after wiping, in the toilet bowl, or on the stool itself. This bleeding is typically painless.
Other symptoms include:
- Persistent itching or irritation around the anal region.
- Discomfort and pain, particularly when sitting or during bowel movements.
- A feeling of incomplete evacuation after a bowel movement.
- Swelling around the anus.
- Mucus discharge, which may appear as clear or white fluid.
When to Consult a Doctor
It is advisable to seek medical attention if symptoms of a prolapsed hemorrhoid persist or worsen. If you experience bleeding during bowel movements, or if your discomfort, pain, or itching does not improve after a week of home care, medical consultation is appropriate. It is particularly important to see a doctor if there is significant bleeding, or if you notice a lump that cannot be pushed back inside.
A medical evaluation is also important to rule out other, potentially more serious conditions that can cause similar symptoms, such as colorectal cancer or anal fissures. If you experience severe pain, signs of infection, or notice a hard, discolored lump that suggests a blood clot, immediate medical attention is recommended. A healthcare provider can accurately diagnose the condition and recommend the most suitable treatment.