Prolapsed Hemorrhoids
Prolapsed hemorrhoids occur when the tissue that holds them in place weakens. Straining or pressure on the hemorrhoids may cause them to enlarge and protrude.
Non-modifiable factors (factors a person cannot change or control) that increase the risk of prolapsed hemorrhoids include:
- Age: Being over the age of 50.
- White race: People of white race.
- Menopause: The hormonal changes associated with menopause can contribute to the development of hemorrhoids and their prolapse.
- Rachidian anomaly (anomalies or abnormalities in the spine).
- Personal or family history of genital prolapse.
- Previous pelvic surgeries.
Modifiable factors (factors a person can change or control) that increase the risk of prolapsed hemorrhoids include:
- Chronic constipation: Long-term difficulty with bowel movements can contribute to the development of prolapsed hemorrhoids.
- Obesity: Excess weight can place strain on rectal veins and increase the risk of developing prolapsed hemorrhoids.
- Vaginal delivery: Vaginal delivery may increases the risk of developing prolapsed hemorrhoids.
- Chronic obstructive pulmonary diseases: Certain respiratory conditions can increase the risk of prolapsed hemorrhoids.
- Straining during bowel movements: Straining can put extra pressure on the hemorrhoids, leading to their prolapse.
- Pregnancy: The increased pressure on the veins in the colon during pregnancy can cause hemorrhoids to form and become prolapsed.
- Cigarette smoking: Smoking can harm blood vessels, including those in the rectum and anus, increasing the risk of hemorrhoids and prolapse.
Prolapsed hemorrhoids can cause a range of symptoms, with the severity often increasing as the condition progresses. Here are the common symptoms associated with prolapsed hemorrhoids:
Early Symptoms:
- Rectal bleeding: One of the most common early symptoms of prolapsed hemorrhoids is rectal bleeding. This may appear as bright red blood on the toilet paper or in the toilet bowl after a bowel movement.
- Rectal swelling: Prolapse occurs when an internal hemorrhoid falls through the anus due to straining. It may feel like a lump or bulge around the anus.
Later Stages/Higher Severity Symptoms:
- Pain and discomfort: As prolapsed hemorrhoids progress or become more severe, they can cause pain and discomfort. This may be felt as an aching sensation in the anus, especially when sitting or during bowel movements.
- Itching and burning: People with prolapsed hemorrhoids may experience itching and burning around the anus.
- Difficulty sitting: The pain and discomfort associated with prolapsed hemorrhoids may worsen when sitting for prolonged periods of time.
- Blood clots: In certain cases, a blood clot may form within an external hemorrhoid. This is known as a thrombosed hemorrhoid and can cause increased pain and inflammation.
To diagnose prolapsed hemorrhoids, doctors typically perform a combination of examinations, tests, and procedures. These include:
- History and Visual Examination: Doctors will take a detailed history about any contributing symptoms or factors. They may visually examine the anus or rectum to identify external or prolapsed internal hemorrhoids. They will look for signs of swelling or lumps in the area.
- Digital Rectal Exam: During a digital rectal exam, the doctor inserts a lubricated gloved finger into the anus and rectum to feel for signs of hemorrhoids. This allows them to assess the size and location of internal hemorrhoids.
- Anoscopy: Anoscopy is a procedure where a doctor uses an anoscope, a thin tube with a light on the end, to examine the lining of the anus and lower rectum. This helps in identifying internal hemorrhoids and assessing their severity.
- Laboratory Tests: In some cases, laboratory tests may be performed to evaluate overall health. These tests can include assessing white blood cell count (leukocytosis), C-reactive protein (CRP), procalcitonin (PCT), and lactate levels. These tests help in determining if there are any complications or underlying conditions.
Other examinations, tests or procedures may be recommended based on initial findings or individual factors.
The goals of treatment for prolapsed hemorrhoids are to reduce symptoms, promote healing, and prevent recurrence. There are various treatment options available, including medication types, therapies, therapeutic procedures, health behavior changes, and other treatments. Each of these approaches works in different ways to achieve the treatment goals for prolapsed hemorrhoids. Here are some of the recommended treatments and how they work:
Medications:
- Over-the-counter hemorrhoid remedies: These include creams or witch hazel solutions that can help relieve swelling and pain associated with hemorrhoids.
- Pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen can be taken to reduce pain.
Therapies:
- Cold compress: Applying an ice pack wrapped in a thin towel to the affected area can help reduce pain and swelling.
- Warm water sitz bath: Soaking in warm water for about 10 to 15 minutes can provide relief. Some people also add Epsom salts to the bath for added comfort.
Therapeutic Procedures:
- Rubber band ligation: This procedure involves placing small rubber bands tightly around the hemorrhoid to cut off its blood supply. Within a week or so, the hemorrhoid shrinks and falls off.
- Sclerotherapy: A chemical solution is injected into the hemorrhoid, causing it to shrink by reducing the blood vessels' size.
- Coagulation: Using a laser, infrared light, or heat, the hemorrhoid is hardened and eventually dissolves.
Self-care and Health Behavior Changes:
- Dietary changes: Consuming a high-fiber diet with plenty of fruits, vegetables, and whole grains can soften stools and make them easier to pass, reducing strain during bowel movements.
- Adequate hydration: Drinking enough water helps prevent constipation and promotes regular bowel movements.
- Avoiding prolonged sitting or standing: Taking breaks and moving around regularly can help alleviate pressure on the rectal area.
- Hemorrhoidectomy: This surgical procedure involves removing the hemorrhoid tissue. It is typically reserved for severe cases or when other treatments have not been effective.
- Hemorrhoidopexy: A procedure used for treating grade 4 and some grade 3 prolapsed hemorrhoids. It involves removing all hemorrhoid tissue.
Over time, without treatment, prolapsed hemorrhoids can worsen and lead to various complications.
Natural Progression of Prolapsed Hemorrhoids:
- Prolapsed hemorrhoids can start as small lumps that may retract back into the anus spontaneously or with gentle manipulation.
- Without treatment, they can gradually increase in size and become more frequent.
- As the condition progresses, prolapsed hemorrhoids may no longer retract on their own and may require manual reduction.
- In severe cases, the prolapsed hemorrhoids may become permanently protruded and difficult to manage.
Possible Complications of Prolapsed Hemorrhoids:
- Strangulation: The blood supply to the hemorrhoid can become blocked, causing intense pain.
- Anemia: Excessive bleeding from hemorrhoids can lead to fatigue, shortness of breath, headaches, and dizziness due to blood loss.
- Prolapse: Prolapsed hemorrhoids can cause discomfort or pain when sitting or during bowel movements.
- Blood Clots: Thrombosis is more likely to occur in external hemorrhoids and can cause severe pain and itching.
- Infection: Bleeding hemorrhoids can become infected, leading to complications such as tissue death, abscesses, and fever.
Impact of Treatment for Prolapsed Hemorrhoids:
- Treatment can help cure prolapsed hemorrhoids by reducing their size and allowing them to retract back into the rectum.
- It can also slow down the progression of prolapsed hemorrhoids by preventing further enlargement or prolapse.
- Additionally, treatment can reduce complications by addressing issues such as bleeding, pain, and infection.
Remember that it's important to consult with a healthcare professional for proper evaluation and guidance regarding the management of prolapsed hemorrhoids. They can provide personalized advice based on your specific situation.