A hemorrhoid is a collection of swollen veins and connective tissue in the lower rectum and anus. Prolapsed hemorrhoids are internal hemorrhoids that have enlarged and extended outside the anal opening. Increased pressure can cause internal hemorrhoids to bulge or protrude externally when supporting tissues weaken, allowing them to slip out.
Understanding Prolapse Grades
Internal hemorrhoids are categorized into four grades based on their severity and degree of prolapse. This grading system helps determine the most appropriate treatment. Grade I hemorrhoids are enlarged internal hemorrhoids that may bleed but do not protrude outside the anus.
Grade II hemorrhoids protrude from the anus during straining, such as during a bowel movement, but retract spontaneously. Grade III hemorrhoids prolapse outside the anus during a bowel movement or physical exertion and require manual assistance to be pushed back inside. These can cause significant discomfort and may bleed.
Grade IV hemorrhoids are permanently prolapsed outside the anus and cannot be manually reinserted. These are often painful and can lead to complications like blood clot formation, known as a thrombosed hemorrhoid. This grading system applies only to internal hemorrhoids, as external hemorrhoids are located outside the anus.
Recognizing the Symptoms
A soft lump or bulge around the anus is a primary indicator of a prolapsed hemorrhoid, which may be skin-colored or reddish and can often be felt or seen. Prolapsed hemorrhoids commonly cause itching or irritation in the anal region. Discomfort and pain, especially when sitting or during bowel movements, are also frequent symptoms. Bright red blood on toilet paper or in the toilet bowl after a bowel movement is a common sign. Some individuals may experience mucus discharge from the anus or a feeling of incomplete bowel evacuation.
Common Causes and Risk Factors
Prolapsed hemorrhoids develop due to increased pressure in the anal or rectal area, causing veins to swell and supporting tissues to weaken. Straining during bowel movements, often from chronic constipation or frequent diarrhea, is a significant factor. Hard stools leading to inadequate lubrication can also cause straining and prolapse. Pregnancy, prolonged sitting (especially on the toilet), and obesity are common risk factors that increase pelvic pressure. Additionally, a diet low in fiber contributes to constipation, and weakened tissue due to aging or genetics makes hemorrhoids more prone to prolapsing.
When to Seek Medical Advice and Treatment
Seek medical attention if hemorrhoid symptoms persist or worsen, especially with persistent bleeding, severe pain, or if the prolapsed hemorrhoid cannot be pushed back inside. A healthcare provider can provide an accurate diagnosis and determine the most appropriate course of treatment.
Initial treatment often involves conservative measures to reduce symptoms and prevent further prolapse. These include increasing dietary fiber intake to 25 to 35 grams per day and ensuring adequate fluid consumption to soften stools. Taking warm sitz baths for 10 to 20 minutes several times a day can help relieve pain and inflammation. Over-the-counter topical creams containing ingredients like hydrocortisone, witch hazel, or lidocaine can also reduce discomfort and swelling.
For more persistent or severe cases, medical procedures may be recommended. Rubber band ligation involves placing a small elastic band around the hemorrhoid’s base to cut off its blood supply, causing it to shrink and fall off. Sclerotherapy involves injecting a solution into the hemorrhoid to cause it to scar and shrink. Other non-surgical options include infrared coagulation, which uses heat to harden and shrivel the hemorrhoid. For Grade III or IV prolapsed hemorrhoids that do not respond to other treatments, surgical removal, known as a hemorrhoidectomy, may be necessary.