Hemorrhoids are a common condition involving the swelling of vascular cushions, which are normal structures located within the lower rectum and anus. This swelling occurs when the veins in these cushions become enlarged due to increased pressure. A prolapsed hemorrhoid refers specifically to an internal hemorrhoid that has descended and protruded outside the anal canal.
This descent happens when the supporting tissues that keep the internal hemorrhoid in place weaken and stretch. This causes the cushion to bulge out past the anal opening, often during a bowel movement. Prolapse makes the condition more noticeable and often more uncomfortable than early-stage internal hemorrhoids.
Defining Prolapse and Severity Grading
Prolapse is formally categorized by physicians using a four-grade classification system to assess severity and guide treatment selection. Grade I hemorrhoids represent the mildest form, where the swollen tissue remains strictly inside the anal canal and does not protrude, although bleeding may be present. Grade II hemorrhoids prolapse during straining, such as during a bowel movement, but retract spontaneously back inside the canal afterward.
Grade III means the hemorrhoid prolapses during straining or evacuation but requires manual assistance—the patient must physically push the tissue back into the anal canal. These prolapsed tissues are constantly visible and can be a source of discomfort. Grade IV is the most advanced stage, where the hemorrhoid is permanently prolapsed and cannot be manually pushed back inside. Hemorrhoids at this stage are often painful and are at risk of complications like thrombosis, which is the formation of a blood clot within the tissue.
Common Causes and Associated Symptoms
The underlying cause of prolapsed hemorrhoids is a persistent increase in pressure within the veins of the anal and rectal area. Chronic constipation leading to repeated straining during bowel movements is a primary factor that increases this pressure. Sitting on the toilet for prolonged periods also contributes to the downward force on the vascular cushions.
Additional risk factors include pregnancy, which increases abdominal pressure and volume, and obesity, which places extra strain on the body’s vascular system. A diet low in fiber can lead to harder stools, exacerbating the need to strain. Weakening of the anal or rectal tissue due to aging or prior injuries, such as childbirth, can also predispose an individual to prolapse.
The most recognizable symptom of a prolapsed hemorrhoid is the presence of a soft lump or bulge around the anus. This protrusion can cause a feeling of fullness or incomplete evacuation after a bowel movement, along with anal itching and irritation from exposed tissue or mucus discharge.
Bleeding is a frequent sign, typically appearing as bright red blood on the toilet paper or in the toilet bowl. While the prolapse may not always be painful, it causes discomfort when sitting or during the passage of stool. If the prolapsed tissue becomes thrombosed (clotted), it can result in sudden and severe pain.
At-Home Care and Medical Treatment Options
The management of prolapsed hemorrhoids begins with conservative, self-care measures, which are often sufficient for less severe cases, particularly Grade I and Grade II. Increasing dietary fiber intake, often through supplements like psyllium husk, helps soften stools and reduces the need for straining. Adequate hydration also supports softer bowel movements, which is a foundational step in treatment.
Using a sitz bath, which involves sitting in warm, shallow water for 10 to 15 minutes a few times a day, can help reduce swelling, itching, and discomfort. Over-the-counter topical treatments, such as hydrocortisone ointments and analgesic creams, may be used for short periods to relieve inflammation and pain. These conservative measures aim to alleviate symptoms and prevent the progression of the condition.
For persistent symptoms or higher-grade hemorrhoids, medical interventions are available. Minimally invasive, office-based procedures are often the next step for Grade II and some Grade III cases.
Rubber band ligation is a common procedure where an elastic band is placed around the base of the hemorrhoid to cut off its blood supply, causing the tissue to shrink and fall off. Sclerotherapy involves injecting a chemical solution into the hemorrhoid, which causes it to scar and shrink.
Surgical options are typically reserved for severe Grade III and all Grade IV hemorrhoids, or when less invasive methods have failed. The most definitive procedure is an excisional hemorrhoidectomy, which surgically removes the entire hemorrhoidal tissue for long-term relief. Other surgical techniques, such as stapled hemorrhoidopexy, can reposition the prolapsed tissue back into its normal anatomical location.