Do You Need Surgery for Prolapsed Hemorrhoids? Expert Insights

Is surgery always necessary for hemorrhoids and rectal prolapse?

Hello, Dr.
Ko.
About seven years ago, I experienced a recurrence of hemorrhoids during a hiking activity.
After receiving medication from a physician at the Tri-Service General Hospital, the swelling and pain subsided.
However, I subsequently developed a condition of rectal prolapse.
Initially, I could manually push it back after bowel movements, but it would protrude again during jogging or brisk walking.
Over the past seven years, I have not experienced any swelling, pain, or bleeding; however, the prolapse seems to be worsening over time.

I have a few questions:
1.
If there is no swelling, pain, or bleeding, is surgery necessary?
2.
Will the prolapse continue to increase in size?
3.
Each time it prolapses, I can easily push it back, but it protrudes again with prolonged standing, squatting, or straining.
The protruding tissue is not in a lump form but rather appears as a fleshy piece, and there are no hard masses.

4.
If I do not undergo surgery, will the condition worsen as I age?
Thank you.

A Sheng, 50~59 year old female. Ask Date: 2012/12/12

Dr. Ke Fangxu reply Surgery

1.
Surgery is not necessarily required if there is no pain or bleeding, as it does not affect overall health or quality of life.
2.
Prolapse may worsen over time.
3.
If the prolapse is affecting daily activities, surgical treatment is recommended for better outcomes.

Reply Date: 2012/12/12

More Info

Prolapsed hemorrhoids, also known as hemorrhoidal prolapse, can be a distressing condition for many individuals. It occurs when the hemorrhoidal tissue, which is normally located inside the rectum, protrudes outside the anal opening. This condition can lead to discomfort, but as you've described, it may not always be accompanied by pain or bleeding. Let's address your questions regarding the need for surgery and the potential progression of your condition.

1. Is Surgery Necessary If There Is No Pain or Bleeding?
The decision to undergo surgery for prolapsed hemorrhoids often depends on the severity of the symptoms and the impact on your quality of life. If you are experiencing significant discomfort, difficulty with daily activities, or if the prolapse is becoming more frequent or severe, surgical intervention may be warranted. However, if the prolapse is manageable and does not cause pain or bleeding, some healthcare providers may recommend a conservative approach, including lifestyle modifications, dietary changes (such as increasing fiber intake), and over-the-counter treatments. It's essential to have a thorough discussion with your healthcare provider to evaluate your specific situation and determine the best course of action.

2. Will the Prolapse Get Bigger Over Time?
Hemorrhoidal prolapse can potentially worsen over time, especially if there are contributing factors such as chronic constipation, straining during bowel movements, or prolonged sitting. As the condition progresses, the prolapsed tissue may become more prominent and difficult to manage. Regular follow-ups with your healthcare provider can help monitor the condition and provide guidance on managing symptoms effectively.

3. Nature of the Prolapse:
The description of the prolapsed tissue as "meat-like" rather than granular is consistent with the appearance of prolapsed hemorrhoids. The fact that you can manually reduce the prolapse (push it back in) is a positive sign, but it also indicates that the condition may require monitoring. If the tissue becomes harder or more difficult to reduce, or if you start experiencing pain or bleeding, it would be prudent to seek medical advice promptly.

4. Potential for Worsening with Age:
If left untreated, there is a possibility that the condition could worsen with age. Factors such as decreased tissue elasticity, changes in bowel habits, and other age-related health issues can contribute to the progression of hemorrhoidal prolapse. Preventative measures, including maintaining a healthy diet rich in fiber, staying hydrated, and avoiding excessive straining during bowel movements, can help mitigate the risk of worsening symptoms.

In summary, while surgery may not be immediately necessary if you are not experiencing pain or bleeding, it is crucial to monitor your condition closely. Regular consultations with your healthcare provider can help you make informed decisions about your treatment options. If you notice any changes in your symptoms, such as increased frequency of prolapse, pain, or bleeding, do not hesitate to seek medical attention. Remember, maintaining a healthy lifestyle and addressing any contributing factors can significantly impact the management of your condition.

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