Prolapsed Haemorrhoids – Symptoms, Causes, and Treatment 

What is a Prolapsed Haemorrhoid?

Haemorrhoids are enlarged, swollen veins in the area of your anal opening or lower rectum. A haemorrhoid becomes prolapsed when the veins bulge (or prolapse) out of the anal opening. This causes the tissue that holds it in place to become weakened and prone to injury.  

Based on the location, a prolapsed haemorrhoid can either be internal or external. Haemorrhoids that form inside the rectum and the lining of the anal opening are known as internal haemorrhoids. The external haemorrhoid develops under the skin on the anal opening. The commonly asked questions include ‘Are prolapsed haemorrhoids dangerous’ ‘Are prolapsed haemorrhoids permanent’, ‘How long do prolapse haemorrhoids last?’ and ‘Do prolapsed haemorrhoids go away?’ Let us find out all you need to know about prolapsed haemorrhoids.^2-4   

Types of haemorrhoids – Internal haemorrhoids, External haemorrhoids and Prolapsed haemorrhoids  

Prolapsed haemorrhoids are more commonly seen in the age group of 45-65 years. It occurs more during pregnancy, strenuous activities, and advancing age.² ‘Rectal prolapse’ is a similar condition wherein the entire rectum protrudes through the anal canal.⁵ Your doctor will be able to differentiate a rectal prolapse vs haemorrhoids.⁶ It plays a significant role in the quality of life, despite a high prevalence and low morbidity. 

Symptoms of Prolapsed Haemorrhoids

Around 40% of haemorrhoids are painless and asymptomatic. Pain is more common with external haemorrhoids (thrombosed prolapsed haemorrhoids) than internal haemorrhoids. The most commonly noticed prolapsed haemorrhoids symptoms include²: 

• Bleeding from the anal region 
• Mucous discharge from the anal region 
• Small balloon-like swellings around the anal opening 
• Irritation of tissues surrounding the anal opening 
• Pain/discomfort in the anal region while sitting or standing 
• Difficulty in passing stools 

If you are facing any of these symptoms, seek medical attention without delay.   

Commonly noticed symptoms in patients with hemorrhoids 

Hemorrhoids can be Classified into 4 Types (Grades) Depending on Severity:

Grade 1: Haemorrhoids are usually small and painless inflammations that stay inside the anal opening lining. Minor amounts of blood may be noticed after a bowel movement. 

Grade 2: The anal opening is also affected, and the swelling is larger than in Grade 1. Haemorrhoids may be pushed out of the stool when they pass it, but they usually return to their place later. 

Grade 3: (Prolapsed Haemorrhoids): These develop outside the anal opening. The individual might sense them outside. They need to be physically pushed back with one’s fingertips. 

Grade 4: These haemorrhoids prolapse; they constantly protrude and will fall out again even when forced back into the rectum. Bleeding may or may not be present. If a clot forms or if the prolapsed haemorrhoids are strangled by the anal opening, they may be painful.  

When a vein in your anus or lower rectum swells, it’s called a hemorrhoid. A hemorrhoid that bulges outward from the anus is known as a prolapsed hemorrhoid, and it can be quite painfulA surgical staple fixes the prolapsed hemorrhoid back into place inside your rectum and cuts off the blood supply so that the tissue will shrink and be reabsorbed.

Dr. M.G. Kartheeka, MBBS, MD(Pediatrics)

Causes of Prolapsed Haemorrhoids

• Untreated haemorrhoids subjected to high strain or pressure 
• Pregnancy 
• Elderly individuals (advancing age) 
• Obesity 
• Standing or sitting for long periods 
• Straining during bowel movements 
• Low-fibre diet^4,7 

Prolapsed haemorrhoid causes for development. 

I have seen patients who commonly start working pretty quickly after a hemorrhoidectomy, but patients usually neglect the instructions for precautions like avoidance of straining for stools, lifting heavy weights and performing strenuous activity.

Dr. Ashish Bajaj, M.B.B.S., M.D. in Clinical Pharmacology and Toxicology

Complications

The most common complications of prolapsed haemorrhoids include³: 

• Perianal thrombosis: The painful swelling of tissues occurs when a blood clot develops inside a haemorrhoidal vein blocking the blood flow.  
• Incarceration: This occurs when the haemorrhoid becomes entrapped in the anal muscles and is entirely cut off from the blood supply. Gangrene and excruciating pain can result from this condition. 
• Bleeding from the anal region 
• A drop in blood pressure leads to dizziness. 
• This could lead to severe pain and infection if the blood supply is cut off. 

Diagnosis

Haemorrhoids are frequently diagnosed by your doctor based on your medical history and a physical examination.⁸  

Medical History and Physical Examination:

• A doctor will take your complete medical history and examine the region around your anal opening to see if you have external haemorrhoids. He will also perform a rectal exam using his fingers and maybe perform procedures to check your rectal and anal opening to identify internal haemorrhoids.  
• Anoscopy and rigid procto-sigmoidoscopy are two of the procedures performed to examine the anal canal and the lower intestine and rectum, respectively.⁸ 
• Symptoms, causes, diagnosis, and treatment for haemorrhoids 

Treatment

Management of prolapsed haemorrhoids is usually by a combination of medications and lifestyle changes. The treatment options for prolapsed haemorrhoids depend on the type and grade of the haemorrhoid. Diet and lifestyle modifications and surgical and non-surgical methods may be employed to treat prolapsed haemorrhoids. 

1. Diet and Lifestyle Modifications:

Prolapsed haemorrhoid treatment is by dietary and lifestyle modifications as a preventive approach. The recommendations often include boosting dietary fibre and oral fluid intake, regular exercise, abstaining from straining while using the restroom, and avoiding medications that can cause constipation or diarrhoea. Studies have shown that a fibre supplement consistently reduces symptom severity. However, a proper consultation is a must prior to any type of treatment of haemorrhoid.⁹ 

2. Non-Surgical Management:

Low-grade haemorrhoids can be easily treated non-surgically (Grade I-II and some cases of Grade III). These procedures do not require an additional hospital stay. Prolapsed haemorrhoids treatment without surgery can be done by: ⁹ 

• Rubber band ligation  
• Infrared coagulation  
• Injection sclerotherapy  

3. Surgical Management:

Prolapsed haemorrhoid surgery, as done by a surgeon /proctologist, can be of the following types: ^9,10    

• Haemorrhoidectomy  
• Doppler-guided haemorrhoidal artery ligation  
• Stapled haemorrhoidopexy or procedure for prolapse and haemorrhoids haemorrhoidopexy  
• Laser Haemorrhoid Procedure (LHP) 

4. Treatment in Pregnancy

Prolapsed haemorrhoid pregnancy is most reported in the 3^rd trimester. The treatments include dietary and lifestyle changes, Prolapsed haemorrhoid symptoms in pregnancy may be lessened by performing kegel exercises, lying on the left side, and avoiding constipation. It is best to seek treatment if you suspect haemorrhoids during pregnancy.  

5. Medications

A number of over-the-counter and prescription medications may be helpful. These prescription medications that may help include pills, suppositories, creams, and wipes. However, prolapsed haemorrhoid relief needs medications along with other interventions. 

It is important to consult with a healthcare provider before using any of the available medications. Only a qualified surgeon can determine the best treatment plan for your specific case of haemorrhoids. 

Frequently Asked Questions (FAQs)

References:

1. NHS Choices. Piles (haemorrhoids) [Internet]. NHS Choices. 2020.  Available from: https://www.nhs.uk/conditions/piles-haemorrhoids/ 

2. Migaly J, Sun Z. Review of Haemorrhoid Disease: Presentation and Management. Clinics in Colon and Rectal Surgery [Internet]. 2016 Feb 16;29(01):022–9.  Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755769/ 

3. Slauf P, Antoš F, Marx J. [Complications of haemorrhoids]. Rozhledy V Chirurgii: Mesicnik Ceskoslovenske Chirurgicke Spolecnosti [Internet]. 2014 Apr 1;93(4):223–5.  
4. Available from: https://pubmed.ncbi.nlm.nih.gov/24881480/ 

4. Haemorrhoids | National Health Portal of India [Internet]. www.nhp.gov.in. Available from: https://www.nhp.gov.in/haemorrhoids_mtl 

5. Goldstein S, Maxwell P. Rectal Prolapse. Clinics in Colon and Rectal Surgery. 2011 Feb 23;24(01):039–45. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140332/ 

6. Meher S. Complete rectal prolapse vs prolapsed haemorrhoids: points to ponder. Pan African Medical Journal. 2016;24. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5012736/ 

7. Haemorrhoids [Internet]. medlineplus.gov.  Available from: https://medlineplus.gov/haemorrhoids.html 

8. National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of Haemorrhoids | NIDDK [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. 2019.  Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/haemorrhoids/diagnosis 

9. Lohsiriwat V. Treatment of haemorrhoids: A coloproctologist’s view. World Journal of Gastroenterology. 2015;21(31):9245. Available from: https://www.wjgnet.com/1007-9327/full/v21/i31/9245.htm  

10. Maloku H, Gashi Z, Lazovic R, Islami H, Juniku Shkololli A. Laser haemorrhoidoplasty procedure vs open surgical haemorrhoidectomy: A trial comparing 2 treatments for haemorrhoids of third and fourth degree. Acta Informatica Medica. 2014 Dec;22(6):365. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315650/ 

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