Manual Reduction of Strangulated Internal Hemorrhoids Using Sugar: A Case Report

Emergency hemorrhoidectomy for strangulated internal hemorrhoids should be avoided when possible. Manual reductions can relieve pain and prevent the need for emergency surgery. Herein, we present a 51-year-old female patient. Over the preceding 20 years, she experienced prolapsed internal hemorrhoids every time she defecated and had been performing manual reductions herself. Due to significant pain and difficulty during the manual reduction of the hemorrhoids, she was transported to the emergency room. Anal inspection revealed prolapsed internal hemorrhoids and partial congestion. After 10 minutes of applying Lidocaine Hydrochloride Jelly 2% and Escherichia coli culture suspension/hydrocortisone ointment, the manual reduction was still difficult. Based on previous reports of using sugar to reduce stomal prolapse, we applied sugar directly to the hemorrhoids. Ten minutes later, the number of prolapsed hemorrhoids decreased, and manual reduction was possible. After one day of hospitalization for bed rest, the patient was discharged once it was confirmed that there was no prolapse of the internal hemorrhoids and that her pain had improved. Two weeks later, a grade III internal hemorrhoid was observed, which had markedly reduced in size compared with the time of admission. Using sugar to reduce strangulated internal hemorrhoids manually can be useful due to its simplicity, minimal invasiveness, and cost-effectiveness.