Prolapsed Hemorrhoid Symptoms and Treatment

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Prolapsed hemorrhoids are internal hemorrhoids that protrude out of the rectum.

Hemorrhoids are vascular cushions that support the muscles of your anal sphincter and swell up as needed to help to keep stool from leaking out. Hemorrhoids are classified as internal or external depending on where they lie on your rectum.

A hemorrhoid is considered to be prolapsed when there is protrusion beyond the rectum.

Internal hemorrhoids are classified depending on the level of protrusion:

  • Grade I: These internal hemorrhoids are prominent but do not protrude into the anal canal. Bleeding may occur.
  • Grade II: These internal hemorrhoids prolapse out of the anal canal during a bowel movement, but spontaneously retract back inside.
  • Grade III: These internal hemorrhoids prolapse during a bowel movement or other forms of exertion and have to be manually returned inside.
  • Grade IV: These internal hemorrhoids have prolapsed out of the anal canal and cannot be pushed back in, nor do they remain inside the rectum.

Prolapsed hemorrhoids are typically pain-free. Reasons why a prolapsed hemorrhoid could become painful include:

1. The hemorrhoid has become thrombosed, meaning that a blood clot has formed. Grade IV hemorrhoids run the greatest risk of becoming thrombosed. (Thrombosed hemorrhoids are more likely to be external hemorrhoids.)

2. Edema, swelling has formed within the hemorrhoid.

3. The hemorrhoid has become strangulated, meaning that its blood supply has been blocked due to pressure from the anal sphincter.

Symptoms of Prolapsed Hemorrhoids

The symptoms of prolapsed hemorrhoids are typically as follows:

  • Bleeding, typically bright red, that occurs with a bowel movement. This blood may be seen on the stool, dripped into the toilet bowl or on toilet paper.
  • Itching of the perineum or the anus.
  • Large prolapsed hemorrhoids may trigger a feeling of incomplete evacuation.
  • As stated above, pain may only be present if thrombosis or strangulation occurs.

Diagnosis of a Prolapsed Hemorrhoid

Prolapsed hemorrhoids can be identified by your physician during a rectal examination. Your doctor may also perform a sigmoidoscopy to get a better picture as to what might be happening in your rectum.

Treatment of Prolapsed Hemorrhoids

Most prolapsed hemorrhoids spontaneously reduce, or can be encouraged to reduce through self-care. This includes the use of ice packs, sitz baths and over the counter remedies. It is important to avoid straining and to work to keep your stools soft.

For cases in which hemorrhoids do not spontaneously reduce, or tend to re-occur frequently, there are a variety of medical treatments for prolapsed hemorrhoids. Your doctor will determine which treatment is best for you based on your history and severity of symptoms. Some of these options are relatively non-invasive, including the most common non-operative treatment of rubber band ligation.

There are other less invasive, non-surgical options. In addition, there are several surgical options that might be recommended due to the severity of your symptoms.


Lohsiriwat, V. "Hemorrhoids: From basic pathophysiology to clinical management" World Journal of Gastroenterology 2012 18:2009–2017.

Sanchez, C. & Chinn, B. "Hemorrhoids" Clinics in Colon and Rectal Surgery 2011 24:5–13.

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