What are Prolapsed Hemorrhoids: Signs, Symptoms, Grades, Causes and Complications | Max Hospital

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Prolapsed Hemorrhoids: Understanding The Symptoms, Causes, and Treatments

By Dr. Ashish Sachan in Laparoscopic / Minimal Access Surgery

Jun 25 , 2024 | 6 min read

Before we delve further into prolapsed haemorrhoids, it is important to understand what haemorrhoids are. Commonly called “piles”, haemorrhoids are a condition where the blood vessels in the anus or lower recturm become inflamed and swollen, which can cause discomfort, pain and bleeding. When haemorrhoids protrude beyond the rectum, the condition is referred to as ‘Prolapsed Hemorrhoids’ or ‘Internal Hemorrhoidal Prolapse’. Prolapsed haemorrhoids can be extremely uncomfortable or painful, especially if they become strangulated or irritated. It is, therefore, strongly recommended for individuals dealing with prolapsed haemorrhoids to consult a gastroenterologist or a colorectal surgery specialist as soon as possible.

Grades of Prolapsed Hemorrhoids

Depending upon the extent of protrusion and reducibility, haemorrhoids can be classified into four degrees or grades. These are:

  • Grade 1: Haemorrhoids are typically small and painless inflammations that remain within the lining of the anus. Minor amounts of blood may be noticed after a bowel movement.
  • Grade 2: The anus is also affected, and the swelling is more pronounced. Haemorrhoids may protrude during a bowel movement, but return to their normal position afterwards.
  • Grade 3: Develop outside the anus and can be felt externally. They require physical manipulation, usually with one's fingertips, to be pushed back into place.
  • Grade 4: Haemorrhoids constantly protrude and do not stay inside the rectum. They may even fall out when pushed back in. Grade 4 haemorrhoids are at a high risk of strangulation and require specialist treatment, including surgery.

Prolapsed Hemorrhoids Signs and Symptoms

Haemorrhoids can have different symptoms and vary in severity. The most common symptoms of prolapsed haemorrhoids are:

  • Bleeding from the anal region: One of the signs of haemorrhoids is rectal bleeding, often noticed during or after bowel movements.
  • Mucous discharge from the anal region: Some individuals may experience a mucous discharge from the rectum, which can be a sign of hemorrhoidal irritation.
  • Small balloon-like swellings around the anus: Prolapsed haemorrhoids can sometimes appear as small, soft swellings or lumps around the anal opening.
  • Irritation of tissues surrounding the anus: Haemorrhoids can lead to itching and irritation in the anal area, causing discomfort.
  • Pain/Discomfort in the anal region while sitting or standing: Pain is more commonly associated with external haemorrhoids, especially thrombosed prolapsed haemorrhoids. This pain can make sitting or standing for extended periods uncomfortable.
  • Difficulty in passing stools: Haemorrhoids can contribute to difficulty during bowel movements, often resulting in straining or discomfort.

If individuals are experiencing any of these symptoms, seeking medical attention promptly to receive proper evaluation and treatment is crucial.

Prolapsed Hemorrhoid Causes

Several factors can contribute to the development of prolapsed haemorrhoids:

  • Untreated Strain: Chronic strain, heavy lifting, or strenuous activities.
  • Pregnancy: Increased pelvic pressure and hormonal changes.
  • Ageing: Weakened rectal tissues in elderly individuals.
  • Obesity: Added pressure on rectal veins.
  • Prolonged Sitting/Standing: Impaired blood flow.
  • Straining During Bowel Movements: Often due to constipation.
  • Low-Fiber Diet: This leads to constipation and straining.

How is a prolapsed hemorrhoid diagnosed?

A prolapsed haemorrhoid diagnosis involves a combination of clinical history, physical examination, and, if necessary, additional diagnostic tests. Here's a step-by-step overview of how a prolapsed haemorrhoid is typically diagnosed:

Medical history assessment

The physician initiates the diagnosis by taking a detailed medical history from the patient. Key points of inquiry include symptoms, bowel habits, dietary habits, and any family history of haemorrhoids or other gastrointestinal disorders. Common symptoms associated with prolapsed haemorrhoids encompass pain, itching, bleeding during bowel movements, and the presence of a lump near the anal region.

Physical examination

Following the medical history assessment, a thorough physical examination is conducted, consisting of the following components:

  • Visual Inspection: The doctor begins with a visual inspection of the perianal area to identify external haemorrhoids or any signs of prolapse.
  • Digital Rectal Examination (DRE): A digital rectal examination (DRE) is performed, during which the physician assesses the rectum's interior to detect internal haemorrhoids and other abnormalities.
  • Anoscopy (if necessary): If further evaluation is deemed necessary, the physician may employ an anoscope, a short, tubular instrument that allows for a closer examination of the inside of the anal canal and the lower portion of the rectum. 

Prolapsed Hemorrhoid Treatment

In some cases, prolapsed haemorrhoids can heal without medical intervention, but if the condition does not improve or worsens, it is vital to consult with a doctor. Doctors specialising in the treatment of haemorrhoids prescribe various treatments for prolapsed haemorrhoids, ranging from self-care methods to surgery. Commonly prescribed treatments for prolapsed haemorrhoids include:

Self-care treatments 

Individuals experiencing prolapsed haemorrhoids can employ several self-care strategies to manage the condition and prevent deterioration:

  • Ice application: Applying a cold compress to the anus for approximately 15 minutes several times a day effectively reduces swelling and provides relief.
  • Sitz bath: Soaking in a warm bath for 10 to 15 minutes significantly eases discomfort and promotes healing.
  • High-fibre diet: A fibre-rich diet and ample water intake help maintain soft stools. Fibre supplements can be considered for added benefits.
  • Toilet habits: Straining during bowel movements should be avoided. After a bowel movement, gently rinsing the anus with a spray bottle and patting dry with toilet paper or a baby wipe minimises irritation.


If the haemorrhoid does not improve or recurs, individuals may explore over-the-counter (OTC) and prescription medications:

  • Ointments and creams: Over-the-counter products like Preparation H and Dr. Butler's Hemorrhoid & Fissure Ointment contain lidocaine for pain relief and phenylephrine to reduce vein enlargement.
  • Laxatives: Emollient laxatives such as Colace, Correctol, Ex-Lax Stool Softener, and Fleet Sof-Lax can soften stools by drawing in more moisture, facilitating easier bowel movements.
  • Prescription topical ointment: Topical preparations containing hydrocortisone and pramoxine can help reduce the size of the hemorrhoidal vein and numb the surrounding area. Notable brands include Proctofoam HC, Epifoam, and Analpram-HC.


When conservative measures prove ineffective, several specialist procedures can be considered to shrink or remove prolapsed haemorrhoids:

  • Rubber band ligation: This procedure involves tightly wrapping a band around the hemorrhoidal vein to cut off blood flow, leading to shrinkage.
  • Sclerotherapy: An injection of a sclerosing agent induces scarring in the vein, rerouting blood through healthier vessels.
  • Infrared coagulation: Infrared light is employed to coagulate (clot) the vein, effectively cutting off its blood supply.

Hemorrhoid surgeries

Surgery may become necessary to address prolapsed haemorrhoids in severe cases or when alternative treatments fail. Various surgical options are available:

  • Hemorrhoidectomy: A standard surgical procedure performed using a scalpel and stitches. Anaesthesia options include local, regional, or general, with recovery times ranging from two to six weeks.
  • Stapled hemorrhoidectomy: Often performed under local anaesthesia, this procedure employs surgical staples to cut off blood flow to the hemorrhoidal vein, resulting in shorter recovery times.
  • Hemorrhoidal Artery Ligation and Recto-Anal Repair (HAL-RAR): A newer procedure that utilises ultrasound guidance to identify and tie off blood vessels supplying the hemorrhoidal vein. Monitored Anaesthesia Care (MAC) ensures patient comfort during the procedure.

Treatment of prolapsed haemorrhoids during pregnancy

Prolapsed haemorrhoids during pregnancy are most frequently reported in the third trimester. They can be effectively managed through dietary adjustments, lifestyle changes, and specific exercises. Symptoms of prolapsed haemorrhoids in pregnancy can often be alleviated by practising Kegel exercises, lying on the left side, and taking steps to prevent constipation. It is advisable for pregnant individuals to seek medical attention if they suspect they may be experiencing haemorrhoids during pregnancy for proper diagnosis and treatment.

Complications of Prolapsed Haemorrhoids

Prolapsed haemorrhoids can lead to various complications, necessitating specialised care and treatment at hospitals in Delhi or elsewhere. These complications include:

  • Venous thrombosis: In some cases, a blood clot can develop within a hemorrhoidal vein, obstructing blood flow and causing painful swelling of the surrounding tissues. These thrombosed haemorrhoids can grow to the size of a grape or even larger.
  • Incarceration and strangulation: Occasionally, a haemorrhoid may become trapped (incarcerated) within the anal muscles, leading to a complete deprivation of blood flow (strangulation). This situation can result in severe pain, rapid tissue death, and the possibility of gangrene, a condition where the affected tissue begins to decay.

How Long does a Prolapsed Haemorrhoid Take to Recover?

Recovery following a hemorrhoidectomy can often span up to four weeks or even longer before you can comfortably return to your regular activities. Conversely, less-invasive procedures like sclerotherapy, coagulation, and rubber band ligation typically entail a much shorter recovery period, often just a few days.

If you or someone you know has been experiencing symptoms of prolapsed haemorrhoids, seek expert medical advice without any delay. The specialists at Max Hospitals are well-equipped to provide personalised care and guidance, ensuring accurate diagnosis and tailored treatment options for prolapsed haemorrhoids. Don't let discomfort or hesitation deter you from seeking help. Contact the dedicated professionals at Max Hospitals to receive the support and specialised care needed to address prolapsed haemorrhoids and regain your comfort and well-being.