Prolapsed hemorrhoids can be interpreted as a complication of the internal hemorrhoids or as a stage of their evolution. They represent the exit of the internal hemorrhoid packages through the anus, during the defecation process. In most of the cases they appear in patients with predisposition to constipation, so it’s very important for those who were diagnosed with internal hemorrhoids to follow the doctor’s instructions and to avoid constipation. Their appearance is usually explained by the fact that during evacuation (especially evacuation of hard feces that form in constipated patients) packages of internal hemorrhoids can be dragged through the anal canal and anus outside the body. Another important factor that contributes to the appearance of this condition is that the fibrous tissue that binds the hemorrhoidal veins to the surrounding stricter of the rectum can sometimes lose its consistency, becoming unable to hold the veins in their place and letting them slide along the anal canal. This situation usually occurs in elderly patients or in those with a long history of evolution of the internal hemorrhoids and is associated with high values of pressure in the venous system of the rectum.

In the situation of the irreducible prolapsed internal hemorrhoids, the most important and painful complication is thrombophlebitis, also known as strangulated hemorrhoidal prolapsed. Impossibility of reduction is given by rapid growth in volume of the prolapsed hemorrhoidal package and by the spasm of the external sphincter. Sometimes, this complication spontaneously cures in two to four weeks. Other times, when the blood supply of the hemorrhoids package is cut down because of pressure exercised by the anal sphincter, the thrombophlebitis can evolve with gangrene of the prolapsed hemorrhoid and ulceration that is difficult to cure. In its extremely severe forms, the hemorrhoidal thrombosis can extend to the pelvic veins, the perianal spaces or at the organs of the pelvis. Sometimes they can produce septic emboli in the liver (through portal vein) or other organs (through inferior vena cava).

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