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 painful.
There are two types of hemorrhoids, and their differences are based on location.
Internal hemorrhoids are those that develop within the rectum. An internal hemorrhoid can become prolapsed if it pushes down from the rectum and bulges out from the anus.
The other kind of hemorrhoid is external, and it forms directly on the anus. An external hemorrhoid can prolapse too.
The rectum is the lowest section of the intestine, and the anus is the opening at the bottom of the rectum through which the body expels feces.
The main sign that you have a prolapsed hemorrhoid is the presence of one or more lumps around the anus. This will only occur if the prolapse is significant.
In some cases, you can gently push a lump back through the anus. While that changes the hemorrhoid’s location and may ease some symptoms, the hemorrhoid is still present.
Prolapsed hemorrhoids tend to be more painful when sitting as opposed to standing or lying down. They may also hurt more during a bowel movement.
Prolapsed hemorrhoids can be especially painful if a blood clot has formed within the hemorrhoid. This is known as a thrombosed hemorrhoid.
A thrombosed hemorrhoid isn’t as dangerous as a blood clot in your heart, for example, but it can be very painful. A thrombosed hemorrhoid may need to be lanced and drained to relieve the pain.
A prolapsed hemorrhoid may also be extremely painful if it’s strangulated, which means the blood supply to the hemorrhoid has been cut off.
If you have an internal hemorrhoid, you may have no noticeable symptoms. In some cases, there may be some bleeding. If you have bleeding, it will likely show up as bright red blood on a tissue when you wipe following a bowel movement.
External hemorrhoids, even if they haven’t prolapsed, may feel uncomfortable and itchy.
A hemorrhoid can become prolapsed when the tissue that holds it in place weakens. There are several possible causes and risk factors for this weakening of the connective tissue.
Straining during bowel movements is one possible cause, as the straining can put extra pressure on the hemorrhoid. You may be more likely to strain if you’re experiencing constipation or diarrhea.
Pregnancy can also increase your risk. Hemorrhoids occur in up to 40 percent of pregnant women, and left untreated, they can become prolapsed.
Obesity is another possible risk factor. Excess weight can put a strain on the rectal veins, causing the formation of hemorrhoids and the prolapse of internal and external hemorrhoids.
Cigarette smoking can also harm any and all of your blood vessels, including the veins in your rectum and anus. That can increase your risk for hemorrhoids and prolapsed hemorrhoids.
If you have symptoms of a prolapsed hemorrhoid, see a doctor.
Sometimes the hemorrhoid may retreat away from the skin on its own and not cause any more symptoms.
But if pain, itching and bleeding persist, see a primary care physician, proctologist (a doctor who specializes in conditions of the anus and rectum), or gastroenterologist (a doctor who specializes in conditions of the stomach and intestines).
If you feel a lump around your anus, even if there are no other symptoms, you should see a doctor. You want to make sure that lump is actually a hemorrhoid and not a tumor or other health concern.
A prolapsed hemorrhoid may be easily visible during a doctor’s examination. They may also perform a digital exam.
During a digital exam, the doctor will insert a gloved, lubricated finger into your anus and up into the rectum to feel for hemorrhoids.
Internal hemorrhoids are graded based on the degree of prolapse:
Internal hemorrhoid grade
prolapse that retreats on its own (for example, after a bowel movement)
prolapse that you or your doctor can push back in
prolapse that can’t be pushed back in
A grade 4 prolapsed hemorrhoid is likely to be the most painful.
You may not need treatment from a doctor. There are several things you can do at home to relieve symptoms while the hemorrhoid’s swelling subsides:
. Try over-the-counter hemorrhoid products, such as topical ointments or suppositories that contain hydrocortisone.
. Eat more high-fiber foods, such as fruits, vegetables and whole grains, that can soften stool and ease straining during bowel movements.
. Soak in a warm bath for 10 or 15 minutes.
. Use a moist towelette or a similar damp wipe after a bowel movement, but make sure it doesn’t contain alcohol or perfumes.
. Use ice packs around the hemorrhoid to reduce swelling.
If home care doesn’t work and the hemorrhoid is bleeding or painful, a few treatment options are available. Treatment will depend on the type and grade of the prolapsed hemorrhoid.
Treatment options for prolapsed hemorrhoids are generally the same as treatments for other types of hemorrhoids.
Fewer than 10 percent of all hemorrhoid cases are treated surgically. Instead, your doctor will first consider less invasive treatments for prolapsed hemorrhoids.
During this procedure, which is also known as hemorrhoid banding, the doctor will place one or two small rubber bands tightly around the hemorrhoid, cutting off circulation to it. Within a week or so, it will shrink and fall off.
There is usually some bleeding and pain for the first couple of days, but complications are unusual.
Sclerotherapy may be best for grade 1 or 2 hemorrhoids. It isn’t always as effective as rubber band ligation.
For this procedure, your doctor will inject the hemorrhoid with chemicals that shrink the blood vessels in the hemorrhoidal tissue.
For coagulation, your doctor will use a laser, infrared light, or heat to harden the hemorrhoid. Once hardened, the hemorrhoid can dissolve.
You may have minor discomfort with this method and few complications. The chances of a hemorrhoid recurring are higher with coagulation than with other in-office treatments.
An external hemorrhoid with a blood clot can be treated surgically with an external hemorrhoid thrombectomy.
This minor operation involves the removal of the hemorrhoid and the draining of the wound. Ideally, the procedure should be done within three days of the clot’s formation.
A more involved operation to treat grade 4 and some grade 3 prolapsed hemorrhoids is a full hemorrhoidectomy. During this procedure, a surgeon will remove all hemorrhoid tissue.
While it’s effective in treating the symptoms of the hemorrhoid, recovery from this operation can be long and painful.
Complications, such as incontinence, can also develop from a full hemorrhoidectomy.
Having a bowel movement after any hemorrhoid procedure can be uncomfortable. This is especially true after surgery.
Your doctor will probably want you to have a bowel movement within 48 hours. You may be given a stool-softening medication to make it less painful.
It may take up to four weeks or longer before you can resume your usual activities after a hemorrhoidectomy. Recovering from the less-invasive procedures, such as sclerotherapy, coagulation, and rubber band litigation, may take just a few days. Sclerotherapy and coagulation may take a few sessions to be successful.
A prolapsed hemorrhoid can be painful, but it’s usually treatable. Respond to symptoms promptly, as treatment is easier and less painful if the hemorrhoid hasn’t had a chance to enlarge.
If you’ve had one or more hemorrhoids, you may be susceptible to more in the future. Talk with your doctor about diet, weight loss, and other lifestyle changes you can make to reduce your odds of future problems.