Haemorrhoids appear when veins in the rectum and anus come under strain and swell, producing lumps that can be itchy, painful, and can even bleed in certain circumstances. Haemorrhoids can be internal or external.
When an internal haemorrhoid in the anus bulges out into the rectum it becomes a prolapsed haemorrhoid. These can be very painful.
While internal haemorrhoids form within the rectum and push their way outside the anus, external haemorrhoids appear on the anus directly and can also prolapse. In both instances, prolapsed haemorrhoids can be alarming for those who suffer from them.
Internal haemorrhoids are graded as follows: 1) No prolapse; 2) Prolapse that is self-retreating; 3) Prolapse that can be pushed back into the rectum, 4) Prolapse that can’t be pushed back in. Grade 4 prolapsed haemorrhoids are, unsurprisingly, the most painful for sufferers.
How to know if you have a prolapsed haemorrhoid
A prolapsed haemorrhoid manifests itself as a lump (or several lumps) around the anal region which only appear if there is substantial prolapse. A prolapsed haemorrhoid will also be significantly more painful than a haemorrhoid which has not prolapsed. In some instances, prolapsed haemorrhoids can be pushed back through the anus into the rectum, though this is only a temporary measure.
Prolapsed haemorrhoids are often most painful when the sufferer is sitting and exerting more pressure on the anus. They will also hurt when the sufferer passes stool, or if the haemorrhoid becomes thrombosed (when a blood clot forms inside the haemorrhoid). Thrombosed haemorrhoids often need to be dealt with by a medical professional, and may require a specific treatment.
Why do haemorrhoids become prolapsed?
Haemorrhoids become prolapsed when the connective tissue holding them to the rectal wall become weakened, causing it to elongate and extend through the anus. Added strain on the haemorrhoid (during bouts of constipation or diarrhoea) can weaken the tissue and loosen its grip, causing it to prolapse. Other factors around prolapsed haemorrhoids include obesity (excessive and unrelenting strain placed on the rectum causes haemorrhoids to form and then prolapse) and the use of cigarettes or excessive alcohol consumption (both of which can weaken rectal veins and increase the risk of prolapse). In addition, pregnant women are also more at risk of getting haemorrhoids and having them prolapse if left unseen-to.
How to know if a haemorrhoid hasn’t prolapsed yet
Internal haemorrhoids produce no real symptoms, so you may not be aware you have them at all. In certain circumstances you may experience some bleeding from within the rectum, which will appear bright red on toilet paper after you use the loo. External haemorrhoids, on the other hand, are likely to feel itchy and possibly even painful before they’ve prolapsed.
Dealing with a prolapsed haemorrhoid yourself
Haemorrhoids usually clear up on their own after a short time, but they may remain itchy and uncomfortable during the time they’re present in your body. However, there are several approaches you can take to deal with them until they’ve gone.
First, examine your diet and see how you can change it to reduce strain on your body, particularly the rectal and anal regions. Increase your intake of high-fibre foods such as fresh fruit, vegetables and whole grains – this can help make your stool softer and, consequently, much easier to pass. Harder stool equates to increased strain on rectal veins, which can cause haemorrhoids or make them prolapse. You should also drink more water and less coffee when you have haemorrhoids.
Next, try a Sitz bath or a cold or warm compress to help reduce swelling around the anus. Reducing swelling and inflammation can lead to faster recovery from haemorrhoids, whether they’re prolapsed or not. It’s also a good idea to pat yourself dry after cleaning the affected area rather than rubbing it, as abrasion may make things worse.
Finally, you can purchase products from your local pharmacy to help treat haemorrhoids. Suppositories, creams and ointments can lower irritation, swelling and inflammation – just avoid anything that’s perfumed.
What to do if home remedies don’t work
In many cases, home remedies are enough to deal with prolapsed haemorrhoids, or at least make them manageable. Sometimes, however, extra attention is required. You should always see a doctor immediately if you suspect you have a prolapsed haemorrhoid. If a haemorrhoid begins to bleed or is excessively painful, the sufferer may need to see a doctor a second time for more substantial treatment. Prolapsed haemorrhoids are usually treated by physicians in the same way normal haemorrhoids are, and only a small percentage of them ever require surgical treatment.
Haemorrhoids often clear up of their own accord, and can do so fairly quickly. However, sometimes they persist no matter what treatment has been administered, and you may need to see a specialist. A proctologist (a medical professional specialising in problems with the rectum and anus) or a gastroenterologist (focusing on the stomach and intestines) would be the most likely people your GP would refer you to.
There are many treatments available for haemorrhoids, surgical and non-surgical, the latest being a radio frequency based treatment called The Rafaelo Procedure. It might be that your GP is not familiar with the treatment but check out the Rafaelo website to see where your nearest clinic is.
In all cases, as soon as you feel a lump in your anus, you should consult your doctor immediately. While a lump is often symptomatic of a prolapsed or external haemorrhoid, it can also be a sign of a much more serious condition, and should be addressed as soon as possible.
What will the doctor do during the examination?
If a haemorrhoid is indeed prolapsed, the doctor will be able to see it easily and diagnose the problem there and then. In some cases, though, a digital examination may be required, in which case the doctor will insert a finger (gloved and lubricated, of course) into the anus and rectum to check for haemorrhoids. This may feel invasive, but is a requirement for diagnosis.
Recovering from prolapsed haemorrhoids
In the wake of a haemorrhoid examination or procedure, bowel movements may feel more uncomfortable than usual as the anal region has experienced increased strain or abrasion. Your doctor will most likely require you to pass stool within the next 48 hours and may give you a suppository to help the process along. Several weeks of recovery may be required after a surgical procedure for prolapsed haemorrhoids.