Hemorrhoid Prolapse: Causes, Treatments, and Recovery - Surgery

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Hemorrhoidal prolapse


Hello Dr.
Ke, I visited the clinic two weeks ago for hemorrhoids.
I actually only had two small external ones, and I had never experienced any bleeding or pain.
I informed the doctor during the visit that I had no discomfort, but he still recommended ligation for the internal hemorrhoids and suggested to leave the external ones alone.
The first ligation was manageable, but the second one turned into a nightmare.
The day after the ligation, a third internal hemorrhoid prolapsed and could not be pushed back in, causing persistent bleeding and pain upon pressure.
When I returned for a follow-up, the doctor explained that the other two ligated hemorrhoids had shrunk, which led to the third one being unable to be held in place, resulting in the prolapse.
Now, I can only consider conservative treatment or surgery.
It’s hard to accept that I went from having no issues to this after the ligation.

I would like to ask you, Dr.
Ke, I have been experiencing a slight amount of blood and fluid for about a week after the ligation.
I have to change my pad every time I use the restroom.
Is this bleeding and pain caused by the ligated hemorrhoid or the prolapsed one? The doctor prescribed me medication for swelling for two weeks and mentioned that the bleeding is not a concern and will eventually resolve, is this normal? Additionally, the prolapsed hemorrhoid is quite large and painful to the touch, and I notice some blood when I wipe with tissue.
Currently, I am taking the swelling medication, hemostatic medication, applying ointment, and doing sitz baths.
Is there a chance for improvement without surgery? I apologize for asking so many questions, but I am suddenly facing these inconvenient issues with hemorrhoids, which is quite concerning.
Thank you!

yu, 50~59 year old female. Ask Date: 2020/06/27

Dr. Ke Fangxu reply Surgery


Typically, there is not much bleeding after a vasectomy.
Based on your description, it seems more like a prolapsed hemorrhoid causing the issue.
Indeed, a swollen prolapsed hemorrhoid will gradually resolve, and during this time, there may be some bleeding.
As long as the bleeding is not severe, it is generally not a concern.
For thrombosed external hemorrhoids that are swollen and prolapsed, the treatment depends on their size.
If they are not large, conservative treatment may suffice for resolution.
However, if they are large and causing pressure on the sphincter, surgical removal or thrombectomy may be a better option.

Reply Date: 2020/06/27

More Info


Understanding hemorrhoid prolapse can be quite complex, especially when it involves treatments like rubber band ligation and the subsequent complications that may arise. Hemorrhoids are swollen veins in the lower rectum and anus, and they can be classified as either internal or external. Internal hemorrhoids are located inside the rectum, while external hemorrhoids are under the skin around the anus.
In your case, it seems that you initially had a few external hemorrhoids that were not causing significant discomfort or bleeding. However, your doctor recommended rubber band ligation for the internal hemorrhoids, which is a common procedure aimed at reducing the size of hemorrhoids by cutting off their blood supply. This procedure can be effective, but it also carries risks, as you've experienced.

The complications you described, including the prolapse of another internal hemorrhoid after the ligation, are not uncommon. When one or more hemorrhoids are treated, the remaining hemorrhoids may become more prominent due to the changes in pressure and blood flow in the area. This can lead to a situation where a previously stable hemorrhoid may prolapse, as you have experienced. The bleeding and pain you are experiencing could be attributed to both the ligated hemorrhoid and the newly prolapsed one.
The fact that you are experiencing slight bleeding and discomfort after the procedure is not unusual. After rubber band ligation, it is common for patients to have some bleeding, especially when having bowel movements. This bleeding is usually minor and should resolve over time. However, if the bleeding is significant or accompanied by severe pain, it is essential to follow up with your healthcare provider.

Regarding your current treatment regimen, which includes anti-inflammatory medication, hemostatic agents, and topical ointments, these are standard approaches to manage symptoms and promote healing. Sitz baths can also be beneficial, as they help soothe the area and promote blood flow, which can aid in recovery.

As for the possibility of avoiding surgery, it largely depends on how well your symptoms improve with conservative management. Many patients find relief with non-surgical treatments, especially if they adhere to a high-fiber diet, stay hydrated, and avoid straining during bowel movements. However, if your symptoms persist or worsen, surgical options may need to be reconsidered.

In summary, while your experience with hemorrhoid ligation has been challenging, it is essential to maintain open communication with your healthcare provider. They can monitor your condition and adjust your treatment plan as necessary. It is also crucial to be patient, as recovery can take time, and many patients do see improvement with conservative measures. If you have any further concerns or if your symptoms do not improve, do not hesitate to seek further medical advice.

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