An Overview of Prolapsed Hemorrhoids

Prolapsed hemorrhoids are swollen veins located inside the rectum, the last part of the large intestine, that bulge out. They are different from external hemorrhoids, which are swollen veins on the outside skin of the anus.

Prolapsed hemorrhoids are not usually painful, but they can cause discomfort, bleeding, and itching that can interfere with sitting, using the bathroom, and going about daily life comfortably.

In many cases, prolapsed hemorrhoids may shrink on their own or with the use of at-home treatment. Medical or surgical treatment may also be necessary.

Here's a closer look at the symptoms, risk factors, diagnosis, and treatment of prolapsed hemorrhoids.

Symptoms

`The most common symptoms of prolapsed hemorrhoids include:

• A lump: You may feel a bump on your anus when you wipe after a bowel movement. This is the swollen vein, and it may be tender when touched, tender all the time, or painless.
• Bleeding: You may notice blood in the toilet, on the toilet paper when you have a bowel movement, or even on your underwear. The blood is typically bright red and very watery. Blood that comes from the stomach or from intestinal bleeding is usually dark, black, or tarry.
• Itching: The skin around your anus may be very itchy when you have a prolapsed hemorrhoid.
• Discomfort: Large prolapsed hemorrhoids may trigger a general feeling of discomfort or a sense of incomplete evacuation of your bowels, or feeling like you still need to pass stool after a bowel movement. There may be tenderness when a bowel movement or anything else touches your hemorrhoid. The pressure of sitting down may also irritate it.

Complications

A prolapsed hemorrhoid may become severely swollen, obstructing your bowel movements. While a little bleeding is common, in some cases, they can suddenly bleed profusely, causing severe blood loss which can even be life-threatening.

Prolapsed hemorrhoids are more likely to bleed or become thrombosed (clotted) or strangulated (pinched such that the blood supply is cut off) than hemorrhoids that are not prolapsed.

Causes and Risk Factors

The underlying cause of hemorrhoids that form in the anus or rectum is still a matter of debate. One theory is that it is due to the breakdown of the supporting tissues in the anal canal.

When hemorrhoids are untreated, last for a long time, or are under more physical pressure, they can become prolapsed and protrude out of the anus or rectum.

There are several risk factors for prolapsed hemorrhoids, including:

• Advanced age
• Constipation
• Dehydration
• Diarrhea
• High-fat/low-fiber diet
• Lack of physical activity
• Obesity
• Overuse of anti-diarrhea medications
• Pregnancy (especially after giving birth)

Sometimes, placing something in the anus, such as during sexual activity, or for medical treatment, can also cause pressure, resulting in a prolapsed hemorrhoid.

Diagnosis 

A hemorrhoid is considered to be prolapsed when it protrudes (sticks out) beyond the rectum. Your healthcare provider can identify them during a physical examination.

Internal hemorrhoids are classified depending on how much they protrude:

• Grade I: These internal hemorrhoids are prominent but do not protrude into the anal canal. Bleeding may occur.
• Grade II: These prolapse (bulge) out of the anal canal during a bowel movement, but go back inside on their own.
• Grade III: These prolapse during a bowel movement or other forms of exertion and have to be pushed back inside.
• Grade IV: These have prolapsed out of the anal canal and cannot be pushed back in. Grade IV hemorrhoids may become strangulated if the blood supply becomes blocked due to pressure from the anal muscles.

Treatment

Most prolapsed hemorrhoids will shrink and return to normal on their own, but you may need at-home remedies, medication, or surgery if your hemorrhoid does not improve.

Self-Care

The following self-care strategies can help shrink or prevent the worsening of a prolapsed hemorrhoid.

• Apply ice packs. Icing the area can reduce swelling.
• Take a sitz bath. Soaking in a warm bath for 10 to 15 minutes can help ease discomfort.
• Avoid straining during bowel movements. Keep your stools soft by eating foods high in fiber and drinking plenty of water.
• Stay active. Walking regularly can help increase blood flow and prevent constipation.
• Limit or avoid alcohol and caffeine. These can both be dehydrating and can cause dry stool that aggravates the hemorrhoid.

Medication

If your hemorrhoids do not get better, or if they come back, there are a variety of medical treatments you can use, including:

• Over-the-counter (OTC) topical ointments
• OTC stool softeners
• Prescription stool softeners

Procedures

Several procedures can shrink, remove, or decrease blood flow to a prolapsed hemorrhoid that cannot be treated with more conservative measures.

The most common procedure for the treatment of a prolapsed hemorrhoid is a rubber band ligation, which cuts off blood flow to the vein by wrapping a band tightly around it. This results in the shrinking of the hemorrhoid.

Other options include:

• Sclerotherapy: Injection of a material that causes the vein to shrink
• Coagulation: Use of infrared light to cut off blood supply to the vein, causing it to shrink

Surgery is a more invasive way to tie off or remove a prolapsed hemorrhoid. Surgery may be necessary if your prolapsed hemorrhoid can't be treated with the other options.

Summary

The most common symptoms of prolapsed hemorrhoids include lumps on the anus, discomfort, itching, and bleeding. These symptoms are not painful but can interfere with daily activities like sitting and using the bathroom.

A high-fat/low-fiber diet, dehydration, lack of physical activity, diarrhea, constipation, overuse of anti-diarrhea medications, advanced age, and pregnancy can all cause hemorrhoids to prolapse. While treatment can vary depending on the severity of your internal hemorrhoid, it may include self-care strategies, medications, procedures, or surgery.

A Word From Verywell

Hemorrhoids are very common, and prolapsed hemorrhoids are also not unusual. They typically improve on their own, but they can persist and require medical or surgical treatment. Healthy lifestyle habits can help prevent prolapsed hemorrhoids from developing in the first place, and often, adopting healthy habits can shrink them permanently.