Hemorrhoids are a common condition involving the swelling of veins in the rectum and anus. A prolapsed hemorrhoid is an internal hemorrhoid that has become enlarged and descended, pushing out through the anal opening. This protrusion can cause significant discomfort, irritation, and sometimes bleeding. Non-surgical approaches are highly effective for managing symptoms, treating the underlying cause, and often eliminating the issue entirely. Treatment begins with immediate at-home symptom relief, progresses to long-term lifestyle changes, and includes minimally invasive medical procedures when necessary.
At-Home Relief for Acute Symptoms
Immediate relief focuses on reducing the swelling and pain associated with the prolapsed tissue. A simple and soothing method is a warm sitz bath, soaking the anal area in plain warm water for 10 to 20 minutes. Repeating this process two to three times a day helps relax the anal sphincter muscles, promoting blood flow and reducing inflammation. Plain warm water is sufficient and avoids potential irritation from additives like Epsom salts.
Cold therapy can also be applied to constrict blood vessels and numb the area, providing quick relief from acute pain and swelling. Apply an ice pack wrapped in a cloth to the affected area for only 10 to 15 minutes at a time to prevent skin damage. Over-the-counter (OTC) topical treatments offer further management for discomfort.
Medicated pads or wipes containing witch hazel act as an astringent, helping to reduce swelling, control minor bleeding, and soothe irritation. Ointments and creams often contain hydrocortisone, a corticosteroid that decreases inflammation, or phenylephrine, a vasoconstrictor that temporarily shrinks swollen blood vessels. These topical products are intended for short-term use while long-term strategies take effect.
Dietary and Habit Changes for Prevention
The root cause of most hemorrhoids is excessive pressure on the rectal veins, often resulting from straining during a bowel movement. The most effective long-term strategy involves maintaining soft, easy-to-pass stools to eliminate the need to strain. This is achieved primarily through a significant increase in dietary fiber and fluid intake.
Adults should aim for a daily fiber intake of approximately 25 to 35 grams, balancing soluble and insoluble fiber. Soluble fiber, found in foods like oats, apples, and beans, dissolves in water to form a gel, softening the stool for easier passage. Insoluble fiber, present in whole grains and many vegetables, adds bulk to the stool, promoting faster movement through the digestive tract.
Fiber requires adequate hydration to function correctly; without water, fiber can worsen constipation. Drinking six to eight glasses of water daily helps keep the stool soft and prevents it from becoming hard and dry. Introduce this higher fiber and fluid intake gradually over several weeks to avoid uncomfortable side effects like bloating and gas.
Proper toileting habits are equally important for prevention. Respond to the urge to have a bowel movement promptly, as delaying it allows the stool to harden. Avoid sitting on the toilet for longer than necessary, typically no more than five minutes, and never strain or force a movement. Elevating the feet on a small stool while on the toilet can help position the body in a natural squatting posture, facilitating easier passage of stool.
Minimally Invasive Medical Treatments
When at-home measures and lifestyle changes fail to resolve prolapsed hemorrhoids, physicians can offer several non-surgical procedures performed in an outpatient setting. These treatments are often recommended for Grade II and Grade III internal hemorrhoids, which prolapse with a bowel movement. These procedures work by reducing the blood flow to the hemorrhoid, causing the tissue to shrink and retract.
Rubber Band Ligation (RBL)
RBL is the most common and highly effective option, particularly for Grade I, II, and III internal hemorrhoids. The procedure involves placing one or two tiny rubber bands around the base of the prolapsed hemorrhoid. This cuts off the blood supply, causing the hemorrhoid to wither and fall off naturally within about one week. RBL is performed above the dentate line, where few pain-sensing nerves minimize discomfort.
Sclerotherapy
Sclerotherapy involves injecting a specialized chemical solution directly into the hemorrhoid tissue. This solution causes the vein to scar and collapse, shrinking the hemorrhoid and preventing further bleeding and prolapse. It is typically used for smaller internal hemorrhoids, such as Grade I and Grade II lesions. Sclerotherapy is generally less effective for larger, more advanced prolapses than RBL.
Infrared Coagulation (IRC)
IRC involves using a brief burst of infrared light to generate heat. This heat is applied to the base of the hemorrhoid, causing the tissue to coagulate, harden, and shrivel. Like sclerotherapy, IRC is reserved for smaller internal hemorrhoids, specifically Grade I and Grade II. It is valued for its minimal side effects and low level of discomfort.
When to Seek Professional Intervention
While home remedies are appropriate for mild discomfort, certain signs indicate that a visit to a healthcare professional is necessary.
- Persistent rectal bleeding requires a medical evaluation to rule out more serious conditions, such as anal fissures or colorectal cancer. Bleeding that is heavy or prolonged warrants urgent attention to prevent complications like anemia.
- Severe pain, especially if sudden and debilitating, can signal a thrombosed hemorrhoid (a blood clot) that requires timely medical treatment.
- Any signs of infection, such as fever, increasing swelling, or discharge from the anal area, necessitate an immediate consultation.
- If a prolapsed hemorrhoid cannot be gently pushed back inside, particularly if accompanied by severe pain, the blood supply may be compromised, requiring specialist care to prevent tissue damage.