Managing Prolapsed Internal Hemorrhoids: Treatment Options and Concerns

Prolapsed Internal Hemorrhoids Issues

Hello doctor, I currently have internal hemorrhoids that have prolapsed outside the anus, and I cannot push them back in.
Initially, it was very painful, so I went to the clinic where I received an injection and medication.
After taking the medication for three days without improvement, I returned to the clinic, and the doctor assessed that surgery was necessary and referred me to a larger hospital.
The doctor at the larger hospital suggested I try a new medication, Eofofurox, and also prescribed a topical ointment, Hiyu Zhi.
I have been taking the medication for three days now, and the pain has decreased somewhat.
I noticed that the internal hemorrhoid seems to have shrunk a little.
I would like to ask if stage IV internal hemorrhoids can be treated with medication alone, as I am quite afraid that the recovery period after surgery will be too long and affect my work.
Also, I forgot to ask how to use the Hiyu Zhi ointment; I am currently applying it to the external portion of the prolapsed hemorrhoid.
Should I apply it internally as well?

Jeremy, 30~39 year old female. Ask Date: 2018/11/03

Dr. Ke Fangxu reply Surgery

Generally, prolapsed internal hemorrhoids tend to respond better to surgical treatment, as the effectiveness of medication alone is limited.
If there is only a prolapse without significant symptoms, surgical intervention may not be necessary, although it can cause inconvenience in daily activities.
It is possible to apply ointment and gently push the hemorrhoid back in, but one should avoid forcing it to prevent injury.

Reply Date: 2018/11/03

More Info

Managing prolapsed internal hemorrhoids can be quite challenging, especially when they progress to a stage where they cannot be pushed back in. In your case, it seems that you are dealing with a fourth-degree internal hemorrhoid, which is the most severe stage. At this stage, the hemorrhoids are permanently prolapsed and cannot be reduced manually.
First, let's address the treatment options. While medications such as the ones you mentioned (艾歐復隆膜衣錠 and 喜愈痔藥膏) can help alleviate symptoms like pain and inflammation, they are generally not sufficient to resolve fourth-degree hemorrhoids. These medications may provide temporary relief and can help reduce swelling, but they do not address the underlying issue of the prolapsed hemorrhoids.
Surgical intervention is often recommended for fourth-degree hemorrhoids. The most common surgical procedure is a hemorrhoidectomy, which involves the removal of the hemorrhoids. While the thought of surgery can be daunting, it is important to consider that this procedure can provide a long-term solution to your problem. Recovery times can vary, but many patients find that their symptoms significantly improve after surgery, allowing them to return to normal activities relatively quickly.
Regarding your concern about the recovery period affecting your work, it is advisable to discuss this with your surgeon. They can provide you with a more accurate estimate of the recovery time based on your specific situation and the type of surgery performed. In many cases, patients can resume light activities within a week or two, but full recovery may take longer, especially if your job involves heavy lifting or prolonged sitting.

As for the application of the topical medication (喜愈痔藥膏), it is typically recommended to apply it to the affected area. If the hemorrhoid is protruding, you can apply the ointment externally. However, if the product instructions or your doctor suggest that it can be applied internally, you may need to use an applicator or your finger to gently insert a small amount into the rectum. Always follow the specific instructions provided by your healthcare provider or the product label.

In summary, while medications can help manage symptoms, they are unlikely to resolve fourth-degree internal hemorrhoids. Surgical options should be considered for a more permanent solution. It is essential to have an open discussion with your healthcare provider about your concerns, treatment options, and recovery expectations. If you are still hesitant about surgery, seeking a second opinion from a colorectal specialist may provide you with additional insights and reassurance.

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