Hemorrhoidal prolapse

What is hemorrhoidal prolapse?

Internal hemorrhoids are veins that surround the lower rectum and anal canal. Therefore, they are in fact a normal part of every individual and are present from birth. However, when they get inflammed and swollen, they may prolapse (protrude through the anus).

Symptoms of hemorrhoidal prolapse

  • Itching: due to irritation from faecal soiling and secreted mucus
  • Feeling of lump in anus: the patient may also complain of feeling like a ball or lump is about to fall out of their anus
  • Bleeding: Usually light bleeding
  • Pain: mainly when the blood supply to internal hemorrhoids has been compromised, it can get gangrenous and consequently very painful

What causes hemorrhoidal prolapse?

Hemorrhoidal prolapse occurs when the enlarged internal hemorrhoid protrudes out of the anus.
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Who can get hemorrhoidal prolapse?

  1. Older people: most common in people aged 45 to 65 years
  2. People from affluent backgrounds are more affected
  3. People with conditions that raise intra-abdominal pressure
  4. Constipation with straining during bowel movements
  5. Pregnancy
  6. Lifting heavy weights
  7. Sitting on the toilet seat for long periods

Grading of internal hemorrhoids

A Grade I internal hemorrhoid bulges into the anal canal during defaecation.
A Grade II internal hemorrhoid bulges from the anus during defaecation, and returns inside on its own.
A Grade III internal hemorrhoid bulges from the anus during defaecation and has to be pushed back.
A Grade IV internal hemorrhoid protrudes from the anus and cannot be pushed back.

Treatment of hemorrhoidal prolapse

Conservative medical treatment: useful for Grade I and II disease

  1. Dietary changes: eating high fibre diet, drinking adequate water (8 to 10 cups per day), reducing fat consumption
  2. Lifestyle modifications: avoiding straining, avoiding sitting in the toilet for long periods, regular exercise
  3. Use of topical treatments with local anesthetics, corticosteroids, or anti-inflammatory drugs. E.g., 0.2% glyceryl trinitrate
  4. Use of pain relievers
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Powerful agent against hemorrhoids and rectal fissures

Nonsurgical Office-based Procedures

The commonest office procedures for internal hemorrhoids are rubber band ligation, sclerotherapy, and infrared coagulation. Rubber band ligation is the most commonly performed office procedure indicated for grade II and III internal hemorrhoids.

Surgery

Surgery is the initial treatment of choice for patients with symptomatic grade IV hemorrhoids or those with strangulated internal hemorrhoids or symptomatic grade III hemorrhoids.

Procedures performed include:

  • Hemorrhoidectomy
  • Stapled hemorrhoidopexy
  • Doppler-guided hemorrhoidal artery ligation



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