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.
Who can get hemorrhoidal prolapse?
Older people: most common in people aged 45 to 65 years
People from affluent backgrounds are more affected
People with conditions that raise intra-abdominal pressure
Constipation with straining during bowel movements
Lifting heavy weights
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
Dietary changes: eating high fibre diet, drinking adequate water (8 to 10 cups per day), reducing fat consumption
Lifestyle modifications: avoiding straining, avoiding sitting in the toilet for long periods, regular exercise
Use of topical treatments with local anesthetics, corticosteroids, or anti-inflammatory drugs. E.g., 0.2% glyceryl trinitrate
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 is the initial treatment of choice for patients with symptomatic grade IV hemorrhoids or those with strangulated internal hemorrhoids or symptomatic grade III hemorrhoids.
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