Prolapsed Hemorrhoids

Hemorrhoids (also known as piles) are swollen blood vessels in or around the anus. Hemorrhoids may be either external (occurring just outside the anus) or internal (occurring just inside the anus in the lower rectum). Prolapsed hemorrhoids are a type of internal hemorrhoid that cause swollen veins to bulge out from inside the rectum.

Anyone can develop hemorrhoids, as this condition is very common. However, most people who experience symptoms of a prolapsed hemorrhoid are between 45-65 years old. Common symptoms of prolapsed hemorrhoids include bleeding, itching, and pain in the anal area.

Home remedies and non-surgical medical procedures can usually relieve symptoms. But more serious cases may require surgery.

Symptoms

Internal hemorrhoids are not usually visible from the outside and often do not cause noticeable symptoms. The most common sign of internal hemorrhoids is bleeding from the rectum. You might find bright red blood in your stools (poop), urine (pee), in the toilet, or on toilet paper. Noticing blood when you use the bathroom can be worrisome, so if you're experiencing this symptom, it's a good idea to see your healthcare provider for a proper evaluation.

When an internal hemorrhoid has become so swollen that it prolapses, or protrudes from the anus, another common symptom is discomfort or rectal pain. This pain can be severe, especially if the hemorrhoid is completely prolapsed. Some internal hemorrhoids prolapse only during a bowel movement (when you poop).

Prolapsed hemorrhoid symptoms often develop gradually and symptoms can come and go. Alongside bleeding and pain, other symptoms of prolapsed hemorrhoids include:

• Itching or irritation around the anus
• Mucus coming out from the anus
• Fecal incontinence (leaky poops)
• A wet sensation around the anus
• A feeling of fullness inside the anus

What Causes a Prolapsed Hemorrhoid?

In general, internal hemorrhoids result from increased pressure on the veins inside the rectum. This can cause the veins in your rectum to weaken and bulge out, causing a hemorrhoid to occur. When an internal hemorrhoid becomes swollen enough and the tissues surrounding it become too weak, your hemorrhoid can become prolapsed.

Risk Factors

Several factors can lead to increased pressure on the veins inside the rectum. If one or more of the following are true for you, you may have a higher risk of developing hemorrhoids:

• Straining to have a bowel movement
• Having long-term diarrhea
• Eating too little fiber
• Using laxatives too often
• Lifting heavy objects regularly

However, some other factors can also weaken the tissues around the veins in the anus, raising the risk that a hemorrhoid will prolapse, including:

• Aging
• Pregnancy
• Genetics

Diagnosis

If you're at an increased risk of hemorrhoids or have symptoms of one, it's important to see your primary care provider for a proper evaluation. If they suspect you have hemorrhoids, they'll likely refer you to a gastroenterologist (a doctor who specializes in digestive tract conditions) or a colorectal surgeon (a surgeon who treats conditions that affect the colon and rectum). Your healthcare team can order and perform several tests to learn about your symptoms and make an accurate diagnosis. 

First, your healthcare provider will ask about your symptoms, when they started, and how often they occur. They will ask about your diet and patterns in your toilet habits. They also will take note of your personal and family medical history. 

Then, your provider will look at your anus to see whether you have a hemorrhoid that has prolapsed. They will also check for signs such as stool leakage, mucus discharge, or anal fissures (small tears in the skin). In some cases, they might ask you to strain as though you are pushing out stool, to see whether an internal hemorrhoid then prolapses.

If they see signs of prolapse, your healthcare provider will need to determine whether the cause is a hemorrhoid, rectal prolapse (the walls of the rectum bulging out), or rectal polyps (growths on the rectum lining). To help them do so, they may perform one of the following tests: 

• Digital exam: Inserting a gloved finger into your lower rectum to assess the muscle tone, check for bleeding, and feel for lumps
• Anoscopy: Inserting a hollow tube with an attached light (called an anoscope) into your rectum to look at the tissues that line your rectum
• Rigid proctosigmoidoscopy: Inserting a short metal tube (known as a proctoscope) to look at the lining of your rectum and lower colon

If you have bleeding, your healthcare provider may suggest a colonoscopy to rule out serious causes of the bleeding, such as cancer. A colonoscopy is a surgical procedure in which a healthcare professional uses a scope to look at your entire colon.

Stages of Prolapsed Hemorrhoids

Healthcare providers assign a grade to internal hemorrhoids depending on how much the hemorrhoid has prolapsed.

• Grade 1: No prolapse
• Grade 2: Some prolapse, but the hemorrhoid can pull back into the rectum on its own
• Grade 3: Some prolapse, but you can push the hemorrhoid back inside the rectum
• Grade 4: Constant prolapse that you cannot push back into the rectum

How To Treat Prolapsed Hemorrhoids

If you receive a diagnosis of hemorrhoids, your treatment plan will depend on what's causing your symptoms and the severity of your condition. If a hemorrhoid is not causing symptoms, it likely does not need medical treatment. However, if a prolapsed hemorrhoid causes pain, bleeding, or other itching, your provider can recommend several treatment options, such as home remedies and medical procedures.

At-Home Treatments

Most prolapsed hemorrhoids will resolve with lifestyle changes and treatments you can perform at home. These methods might include the following:

• Add more fiber to your diet through foods or supplements
• Drink more water and other hydrating liquids
• Use an over-the-counter stool softener if you are constipated
• Try not to sit too long or strain on the toilet
• Take warm, shallow baths (sitz baths) a few times per day
• Reduce pain by taking over-the-counter (OTC) pain relief medications

In-Office Procedures

If at-home treatments are not working for you, your healthcare provider might suggest a non-surgical procedure such as:

• Rubber band ligation: A small rubber band is placed around the base of the hemorrhoid to cut off its blood supply. Eventually, the hemorrhoid shrinks and falls off.
• Sclerotherapy: A chemical solution is injected into the hemorrhoid that creates scar tissue and cuts off the blood supply to the prolapsed hemorrhoid. The hemorrhoid then withers and falls off.
• Infrared coagulation: Heat from a special device creates scar tissue which cuts off the blood supply to the hemorrhoid.
• Electrocoagulation: An electrical current creates the scar tissue which cuts off the blood supply to the hemorrhoid.

Surgery

If your hemorrhoids are severe (e.g., grade 3 or 4 hemorrhoids) and causing complications, you may need a hemorrhoidectomy (a surgery that removes the hemorrhoids with a scalpel or electronic device).

Another surgery your healthcare provider may consider is stapled hemorrhoidopexy. With this procedure, your provider uses a stapling tool to cut out some hemorrhoidal tissue inside the rectum and then reattach it to pull back the prolapsed hemorrhoid inside the anus.

Prevention

The best way to prevent a hemorrhoid from prolapsing is to prevent the hemorrhoid from appearing in the first place. It is important to manage the amount of pressure on your rectum walls, which can increase with certain eating and toilet habits. Adopting new habits may help make stool easier to pass and prevent new internal hemorrhoids. Consider the following strategies:

• Eat more fiber-rich foods, such as beans, fruits (such as raspberries), and vegetables (like green peas)
• Drink more fluids, such as water, natural fruit juices, or clear soups
• Do not strain or sit for long periods on the toilet
• Take an over-the-counter stool softener if necessary
• Avoid lifting heavy objects
• Engage in regular physical activity or exercise
  

Complications

Complications of prolapsed hemorrhoids are rare. However, if left untreated, some prolapsed hemorrhoids can become extremely painful. They also may cause long-term blood loss, which increases your risk of iron deficiency anemia. Symptoms of this type of anemia include headache, muscle weakness, and irritability.

The most serious complication of prolapsed hemorrhoids is becoming “strangulated.” This occurs when the muscles of the anus cut off the blood flow to the hemorrhoid. Strangulated hemorrhoids are very painful, and they can lead to open sores or tissue decay. A strangulated hemorrhoid needs immediate medical attention.

A Quick Review

Hemorrhoids are extremely common, especially as you get older. A prolapsed hemorrhoid is a hemorrhoid that originates inside the rectum but partially bulges out of the anus. While most internal hemorrhoids do not cause symptoms, prolapsed internal hemorrhoids can cause pain, itching, and bleeding.

Home remedies like eating more fiber and taking stool softeners can reduce your risk of hemorrhoids and treat mild cases. Other medical treatments and surgeries can also reduce your symptoms and improve your quality of life.