Managing Prolapsed Hemorrhoids: When to Push Back and Treatment Options

Should prolapsed internal hemorrhoids be pushed back in? Is it possible to reduce swelling through conservative treatment?

Hello Dr.
Ke, I have had constipation issues since I was young.
About ten years ago, due to high stress, I developed hemorrhoids and have had grade III hemorrhoids ever since.
After each bowel movement, a hemorrhoid the size of a finger pops out, but I can easily push it back in without pain or bleeding.
Since I didn't feel it affected my life significantly, I didn't seek treatment.
However, about two months ago, due to staying up late and increased stress, my condition worsened significantly.
I could no longer push it back in myself; one internal hemorrhoid is about 3-4 cm, and there is an external hemorrhoid about 1 cm next to it.
Initially, I visited a doctor within two weeks who helped push it back in, but it was extremely painful, to the point where I couldn't sleep, and painkillers were ineffective.
The doctor mentioned it was a mixed hemorrhoid and possibly thrombosed.
The pain alleviated significantly after about two weeks, and the external hemorrhoid that was originally 1 cm noticeably shrank, but the internal hemorrhoid remains at the anal opening.
I have maintained a regular routine, a light diet, and sitz baths, and I have been having bowel movements almost every day.
Currently, I have not experienced pain or bleeding for a month, but there seems to be no significant reduction in size.
Sometimes I feel it has shrunk a bit, but I'm not sure if it's just a change in shape.
Because the two times the doctor helped me push it back were extremely painful—more painful than not pushing it back—I have been waiting for the swelling to go down before attempting to push it back myself.
A few days ago, I felt it had softened and successfully pushed it back in, but it still feels slightly more painful than when it was not pushed back.
Moreover, the next morning after a bowel movement, the hemorrhoid seemed to have enlarged again, although the pain has disappeared.
I have read a lot about this and still have many questions for you, Dr.
Ke:
1.
Can "reducing the hemorrhoid" really improve symptoms, or should I not force it back in? Could it potentially worsen the condition? I am very concerned that continuous prolapse will make it harder to improve, as I have read that prolapsed internal hemorrhoids can hinder venous return at the anal opening, causing the hemorrhoids to enlarge, making recovery more difficult in the long run.
When the doctor helped me push it back during the initial 1-2 weeks, it did shrink a bit, so I have been wanting to find a way to push it back in, but this time it seems even more swollen, leaving me quite confused.
2.
I am very afraid of surgery and have heard that many women experience reduced swelling after childbirth.
In my situation, is it possible to return to grade III hemorrhoids (able to push back in) without surgery? If there is no pain or bleeding but the prolapse persists, will it have negative effects in the long term?
3.
Does Diosmin help with this condition (grade IV hemorrhoids)? Are there any long-term issues with taking it?
4.
In cases of hemorrhoid prolapse, does aerobic exercise have a beneficial effect, or could it worsen the condition?

Kiki, 30~39 year old female. Ask Date: 2021/07/13

Dr. Ke Fangxu reply Surgery

1.
Personally, I do not recommend pushing acute hemorrhoids back in, as it can be more painful than leaving them out.
Therefore, if the condition is not severe, medication treatment should be used.
If it is indeed very severe, surgical intervention may be necessary.

2.
Since I cannot see your condition, I cannot determine the current severity level.
However, if hemorrhoids are not causing pain, bleeding, or affecting daily activities, surgical treatment is not essential.
3.
Diosmin is a vasoconstrictor used for reducing swelling.
I personally believe its effectiveness is limited, so there is no need for long-term use.
4.
Hemorrhoidal prolapse can worsen due to increased abdominal pressure.
Aerobic exercise should not have an impact, but weight training may increase the risk of exacerbation.

Reply Date: 2021/07/13

More Info

Managing prolapsed hemorrhoids can be quite challenging, especially when dealing with the discomfort and complications that arise from this condition. Your situation, characterized by a long history of hemorrhoids and recent exacerbation, raises several important questions regarding treatment options and management strategies.

1. Repositioning Hemorrhoids: The act of pushing back a prolapsed hemorrhoid can provide temporary relief and may help alleviate symptoms. However, it is crucial to approach this with caution. If the hemorrhoid is too painful to reposition or if it feels excessively swollen, forcing it back may cause further irritation or injury. In your case, since you have experienced significant pain during attempts to reposition the hemorrhoid, it may be wise to avoid this unless you feel confident that the hemorrhoid has softened and can be easily manipulated without pain. Continuous prolapse can lead to complications, including thrombosis or strangulation, where the blood supply to the hemorrhoid is compromised, leading to severe pain and potential tissue death.

2. Surgical Considerations: Many individuals fear surgical intervention, but it is essential to understand that surgery can often provide a definitive solution to recurrent or severe hemorrhoids. While some people experience spontaneous resolution of symptoms post-pregnancy or after lifestyle changes, this is not guaranteed. If your hemorrhoids remain prolapsed and do not improve with conservative measures, surgical options such as hemorrhoidectomy or rubber band ligation may need to be considered. Long-term prolapse without treatment can lead to complications, including chronic pain, bleeding, and even anemia from blood loss.

3. Use of Diosmin: Diosmin is a flavonoid that is often used to treat venous insufficiency and hemorrhoidal symptoms. It may help improve venous tone and reduce inflammation, potentially providing symptomatic relief. However, while Diosmin can be beneficial, it is not a cure for advanced hemorrhoids. Long-term use is generally considered safe, but it is always best to consult with your healthcare provider regarding its use, especially if you have other underlying health conditions or are taking other medications.

4. Exercise and Hemorrhoids: Engaging in aerobic exercise can be beneficial for overall health and may help improve bowel function, which is crucial for managing hemorrhoids. Regular physical activity can promote better circulation and reduce the risk of constipation, a significant contributing factor to hemorrhoid development. However, it is essential to avoid exercises that put excessive strain on the pelvic area, such as heavy weightlifting, as this can exacerbate symptoms. Gentle activities like walking, swimming, or cycling may be more appropriate.

In summary, while managing prolapsed hemorrhoids can be daunting, understanding your options is crucial. If conservative measures do not yield improvement, it may be necessary to consult with a specialist for further evaluation and potential surgical intervention. Regular follow-ups with your healthcare provider can help monitor your condition and adjust treatment as necessary. Remember, addressing lifestyle factors such as diet, hydration, and exercise can significantly impact your symptoms and overall well-being.

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