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Prolapsed Hemorrhoids

Prolapsed Hemorrhoids

A prolapsed hemorrhoid looks like an inflamed, swollen red bump protruding from the rectum. Most prolapsed hemorrhoids are internal hemorrhoids, meaning they develop within the anus. On the other hand, external hemorrhoids develop outside the rectum. In most cases, internal hemorrhoids may not cause any noticeable symptoms unless they become prolapsed.

The protruding, bulging tissues of a prolapsed hemorrhoid may begin to feel irritated or itchy. Fortunately, most hemorrhoids, also known as piles, are not serious and respond well to treatments. Because hemorrhoids are a relatively common condition, understanding the various symptoms and treatments is essential.

What Is a Prolapsed Hemorrhoid?

Hemorrhoids are a common condition, affecting approximately one out of every 20 Americans, with almost half of adults over 50 developing hemorrhoids. Prolapsed hemorrhoids are internal hemorrhoids located within the anal lining that have begun protruding from the anus. When an internal hemorrhoid prolapses, it often causes symptoms similar to external hemorrhoids. The protruding and bulging tissue that extends from the anus is very sensitive and can easily become irritated or itchy.

In some cases, a prolapsed hemorrhoid may even begin to bleed, especially during or after a bowel movement. There are many levels of prolapsed hemorrhoids based on their severity, and they are labeled as grades one through four, with one being the least symptomatic and four being the most severe.


Grade 1 Hemorrhoids

Grade 1 hemorrhoids are internal hemorrhoids that have yet to protrude or prolapse from the inner anal lining. In many cases of grade 1 hemorrhoids, a physician may simply recommend noninvasive hemorrhoid treatments, including over-the-counter hemorrhoid solutions and more fiber in the diet. Over-the-counter hemorrhoid medications can improve various symptoms, including itching, inflammation and irritation.

Grade 2 Hemorrhoids

Grade 2 hemorrhoids protrude from the anus, typically during a bowel movement or when straining, but these hemorrhoids quickly return inward shortly after without interference. Grade 2 hemorrhoids may respond to various conservative hemorrhoid treatments, including some medications or in-office procedures.

Non-surgical hemorrhoid treatments often include sclerotherapy, rubber band ligation and infrared coagulation. These hemorrhoid treatments can only be performed on internal hemorrhoids that have prolapsed and not hemorrhoids originating on the exterior of the anus. Depending on the hemorrhoid’s severity, these treatments often need to be performed multiple times to be effective.

Grade 3 and 4 Hemorrhoids

Grades 3 and 4 are the most severe forms of prolapsed hemorrhoids. A grade 3 hemorrhoid happens when internal hemorrhoids protrude from the anus but do not return into the anal canal without physical intervention. On the other hand, grade 4 hemorrhoids are internal hemorrhoids that prolapse and cannot be reinserted into the anus safely, even with physical intervention.

Treatment for grades 3 and 4 hemorrhoids will vary depending on severity, but many physicians may suggest surgical therapies to improve more severe prolapsed hemorrhoids. Some of the most common surgical treatments for grades 3 and 4 include hemorrhoid stapling and hemorrhoid excision. In most cases, hemorrhoid excision surgery is one of the most common surgeries that provides the best results for more severe hemorrhoids.

Prolapsed Hemorrhoids

Prolapsed Hemorrhoid Symptoms

Symptoms typically arise when hemorrhoids develop externally or internal hemorrhoids prolapse and protrude out of the anus. In some cases, patients may only notice symptoms during or after a bowel movement, which can irritate internal hemorrhoids.

Some patients with prolapsed hemorrhoids may notice mucus or discharge from the anus, especially during or after a bowel movement. Additionally, some patients may feel they cannot wipe away stool after a bowel movement because a prolapsed hemorrhoid is present. While hemorrhoid symptoms vary depending on their severity level, some of the most common hemorrhoid side effects include:

  • External lump: One of the most obvious signs of prolapsed hemorrhoids is a sensitive lump extending from the anus and protruding externally. While some patients may have an external lump that reinserts itself in the anus, other patients may have a severe prolapse, meaning the external lump remains present and cannot be reinserted. You may notice a bump or lump along the anus, especially when wiping following a bowel movement. This external lump is a swollen vein that is tender to the touch and very sensitive.
  • Inflammation: Regularly straining during and after a bowel movement can lead to hemorrhoids, similar to varicose or swollen veins occurring in the anus. Inflammation and swelling are common symptoms associated with hemorrhoids that often occur when anything causes additional pressure on the lower extremities and stomach, directly affecting the rectal veins. Some of the most common reasons inflammation and hemorrhoids occur are from straining due to constipation, experiencing pelvic pressure related to weight gain or pregnancy and straining from lifting heavy objects.
  • Itchiness: Another common symptom of hemorrhoids is persistent itchiness. External and prolapsed hemorrhoids are very sensitive and often come into contact with mucus and other bodily fluids during a bowel movement. Because hemorrhoids are so sensitive, they can easily be irritated and become itchy. The longer a hemorrhoid remains prolapsed, the longer mucus production continues, resulting in additional itching. Stool from a bowel movement mixing with this mucus can also worsen the irritation and itching sensation.
  • Discomfort or pain: Larger and prolapsed hemorrhoids often cause people to feel uncomfortable and, in some cases, may cause pain. Pain and discomfort are typically worse during and after a bowel movement, which can greatly irritate sensitive hemorrhoids. Sitting down, especially on the toilet, can apply pressure on the anus and hemorrhoids, worsening any existing pain or discomfort.
  • Bleeding: Bleeding is another potential symptom of prolapsed hemorrhoids. The sensitive lining of a hemorrhoid can easily become damaged during a bowel movement or when wiping. Excessively hard or dry stools may also irritate or injure a hemorrhoid and lead to bleeding.

Prolapsed Internal Hemorrhoids

Hemorrhoids can develop internally (within the anus) and externally (outside of the anus). An internal hemorrhoid is a swollen and inflamed vein within the rectum. When internal hemorrhoids protrude from the anus, they are known as prolapsed internal hemorrhoids. Internal hemorrhoids are different from external ones, which develop on the skin surrounding the anus and not within the rectum.

Some prolapsed internal hemorrhoids may not be painful, however, they will cause other bothersome symptoms. On the other hand, some prolapsed hemorrhoids can become painful, irritated and swollen, especially when using the bathroom.

Typically, more severe internal hemorrhoids require treatment to improve various symptoms. In some cases, a physician may recommend surgery for more severe hemorrhoids. Prolapsed internal hemorrhoids can disrupt daily life and obstruct your bowel movements. While minor bleeding is a common symptom of internal prolapsed hemorrhoids, severe cases may result in hemorrhoids bleeding uncontrollably. You should seek emergency medical attention in these situations, as this side effect can be dangerous and potentially life-threatening.

Prolapsed hemorrhoids are much more likely to become swollen, bleed and even clot (thrombose). It is also possible for a prolapsed hemorrhoid to be pinched or twisted, which cuts off the circulation and blood supply. Pinched hemorrhoids, also known as strangulated hemorrhoids, can cause serious complications and increase the risk of blood clots forming.

While the underlying cause of hemorrhoids varies and is sometimes unknown, one of the most common risk factors is excess straining. Numerous factors increase the risk of a person developing prolapsed hemorrhoids. Untreated hemorrhoids, especially those under stress or strain, are more likely to become prolapsed than ones that are not under pressure or are being treated.

Some additional most common risk factors for developing prolapsed internal hemorrhoids include chronic constipation, diarrhea or dehydration. Because dehydration can cause firmer, harder stools, these bowel movements can easily irritate the delicate lining of the anus. Old age, obesity and lack of proper diet and exercise can also lead to prolapsed hemorrhoids.

Prolapsed Hemorrhoids

Prolapsed External Hemorrhoids

While many people think of internal hemorrhoids prolapsing, external hemorrhoids can also become prolapsed. Prolapsed external hemorrhoids tend to be the most noticeable, as they often cause various painful or uncomfortable symptoms to develop. External hemorrhoids often become more painful during a bowel movement because stool can easily irritate the sensitive skin around a hemorrhoid.

Many patients may also notice more pain or discomfort with prolapsed external hemorrhoids when sitting because this puts significant strain and pressure on the rectum and hemorrhoids. More intense or persistent pain can occur if a blood clot has formed within the hemorrhoid, known as a thrombosed hemorrhoid. While a thrombosed hemorrhoid is not as immediately dangerous as a traditional blood clot in the body, it can cause severe pain.

Some thrombosed hemorrhoids need to be drained and lanced to alleviate pain and discomfort. Hemorrhoids prolapse when the sensitive tissues holding the hemorrhoid in place weaken. The weakening of this tissue often occurs from excess straining, pregnancy or other factors. Tobacco use and cigarette smoking are also contributing factors for prolapsed hemorrhoids.

Cigarette use negatively impacts your body’s blood vessels, including those in the rectum and anus. Constricted or unhealthy blood vessels may increase the risk of hemorrhoids developing or becoming prolapsed.

Should You Push a Prolapsed Hemorrhoid Back In?

If you notice a prolapsed hemorrhoid, you may wonder if it is bad to push it back in. You can push a hemorrhoid back in if you see it has begun protruding from the anus, but you should always be careful to not force the hemorrhoid if it does not respond to insertion. Fortunately, less severe prolapsed hemorrhoids may go back in by themselves.

Prolapsed hemorrhoids are often graded based on how easily an internal hemorrhoid may be reinserted into the rectum. Typically, grade 1 hemorrhoids do not prolapse and remain inside the rectum. On the other hand, grade 2 hemorrhoids may prolapse and protrude from the anus, but they typically retract naturally without reinsertion.

Grade 3 hemorrhoids are more severe and often prolapse during or after bowel movements. In most cases, they can be reinserted into the anus by gently pushing the hemorrhoid back into the rectum. Finally, grade 4 hemorrhoids are the most severe and cannot be reinserted into the anus.

If you need to reinsert a prolapsed hemorrhoid, it is important to know how to safely and effectively do so. To begin, wash your hands and wear disposable latex gloves. You should place a form of body-safe lubrication on your gloved finger and stand up, bending over with your chest close to your thighs.

You can use one or two fingers to gently insert a prolapsed hemorrhoid back into the rectum. After reinserting a prolapsed hemorrhoid, you can apply a cold compress or ice pack with a cloth on the anus to decrease pain, discomfort and inflammation. You should not apply an ice pack directly to the anus, as this can be damaging and irritating to the sensitive skin.

Prolapsed Hemorrhoids

How to Get Rid of Prolapsed Hemorrhoids

While there are many non-surgical treatments and over-the-counter lotions, some hemorrhoids may not improve or respond to these traditional treatment modalities. How long a prolapsed hemorrhoid lasts depends on the treatment you receive. Most times, over-the-counter therapies only provide temporary relief. In contrast, hemorrhoid banding is a long-term solution that’s non-surgical and performed in-office.


Hemorrhoid banding is a painless treatment that involves placing a rubber band at the base of a hemorrhoid to prevent circulation, resulting in it withering away and falling off. Depending on the severity of your hemorrhoids, you may require multiple banding treatments to properly cut off the blood supply.

Without proper circulation and blood flow, a hemorrhoid naturally and painlessly falls off within a few days. In most cases, patients may not even notice their hemorrhoid has fallen off until they use the bathroom and see it in the toilet. After a hemorrhoid falls off, the body will heal and form a small scar on the surrounding tissues, preventing a hemorrhoid from developing again in the same spot. There are three main types of  hemorrhoid banding procedures, including:


1. Traditional Rubber Band Ligation

Traditional rubber band ligation is when a physician uses metal forceps to hold the hemorrhoid away from the anal lining. Once the doctor has hold of the hemorrhoid, they will place a rubber band around it to reduce blood flow, leading to it drying up and falling off. 

In many cases, traditional rubber band ligation takes approximately five to 10 minutes to perform, with up to three days to recover. Traditional rubber band ligation often causes post-procedure bleeding, pain and discomfort, which may be improved with prescription pain medication.

2. Endoscopic Hemorrhoid Banding

Endoscopic hemorrhoid banding is an innovative form of band ligation using a thin and flexible tube. An endoscope is a slim tube that a physician can insert, similar to forceps. The endoscope is fitted with a plastic cap that contains an elastic band. 

Once the endoscope is inserted into the rectum, a suction device can securely hold the hemorrhoid in place to put the band around the base of the tissue. Endoscopic hemorrhoid banding often requires bowel preparation, fasting and sedation. 

3. CRH O’Regan Hemorrhoid Banding

The CRH O’Regan System is an innovative and less invasive form of rubber band ligation that is less likely to cause discomfort or pain because it does not use metal clamps. Instead, the CRH O’Regan technique uses a disposable ligator, a small plunger device that uses a syringe to gently capture and hold the hemorrhoid. Once the device grabs hold of the hemorrhoidal tissue, it releases a rubber band around it.

With internal hemorrhoids, there are no pain-sensing nerves in this area, preventing discomfort and pain during the procedure. Another benefit of the CRH O’Regan system is that it does not require extensive preparation. Most treatments using this approach are quick and take less than a minute to perform, and they even allow patients to return to work or their daily activities on the same day.

State-Of-The-Art Non-Surgical Hemorrhoid Treatment

The CRH O’Regan System is an innovative and effective non-surgical hemorrhoid treatment that is fast, easy and painless. Because this non-surgical hemorrhoid banding technique is quick and painless, recovery time is significantly shorter than traditional hemorrhoid treatments and surgeries, allowing patients to return to daily activities almost immediately. CRH O’Regan treatment is also covered by Medicare and most insurance plans. To learn more about CRH O’Regan treatment, find a physician near you.