Rectal prolapse and hemorrhoids can look and feel similar. Because of this, telling the difference between them isn’t always easy.
This post explains what each condition is, the causes, symptoms, and treatments available, and when you should go and see a doctor.
What are hemorrhoids?
Hemorrhoids, also called piles, are swollen veins around the rectum and anus. Research suggests that they affect around 38 percent of the population.
Hemorrhoids form for various reasons. Straining at stool is a leading cause. Higher intra-abdominal pressure increases blood pressure in the vessels around the anus, causing damage.
Sitting down for long periods of time is another risk factor. Sedentary work puts you at a higher risk.
Diet also plays a significant role. People who eat insufficient fiber don’t produce large, soft, pillowy stools. Because of this, the rectum and anus need to work harder to push feces out.
Other risk factors include lifting heavy objects, anal intercourse, and chronic constipation.
What is a rectal prolapse?
Rectal prolapse is a condition in which the lower extremity of the large intestine begins to bulge out of the anus. In most cases, the degree of bulging is minimal. However, in complete rectal prolapse, the entire intestinal wall may slip through the anal opening.
Rectal prolapse is rarely an emergency and treatment is relatively straightforward, as we discuss below. However, the condition can be distressing, for obvious reasons.
Can rectal prolapse be mistaken for hemorrhoids?
Patients can sometimes mistake rectal prolapse for hemorrhoids. From the patient’s perspective, the two conditions feel similar. Both produce an itchy sensation around the anus and both lead to bleeding.
External hemorrhoids are particularly confusing. From the outside, they look similar to rectal prolapse when they slip out of the anus. Both look like bright red, fleshy protrusions.
Internal hemorrhoids stay inside the anus. Therefore, they are simpler to diagnose.
How to tell the difference between rectal prolapse and hemorrhoids?
There are key visual differences between rectal prolapse and hemorrhoids.
Hemorrhoids protrude from the inner layer of the bowel and around the opening. They tend to be quite small and only involve a small segment of the total intestinal tissue.
Rectal prolapse, by contrast, is different. It involves the protrusion of the entire bowel through the anal opening, making it appear much larger.
Symptoms of rectal prolapse vs hemorrhoid symptoms
Visual examination will quickly reveal whether a patient has rectal prolapse or hemorrhoids. Symptoms though, also provide valuable information.
Rectal prolapse symptoms include:
- Rectal bleeding – caused by feces coming into direct contact with sensitive, exposed blood vessels
- Incontinence difficulties – trouble holding feces in the rectum before going to the bathroom
- Rectal reinsertion – the need to regularly push the prolapsed section back into the anus
- A sensation of pressure around the rectum
- Pain or discomfort in the anal area – a regular need to scratch
- Excessive straining – often from the start of the bowel movement to the end
- Abdominal discomfort – typically referred pain
- Incomplete bowel movements – several trips to the bathroom may be necessary
Hemorrhoid symptoms are similar, but there are key differences. They include:
- Anal itching – the constant need to scratch the affected area
- Bleeding – often visible on toilet tissue after wiping and in the toilet bowl
- Lumps around the anus – these may feel uncomfortable
- Pain or an aching sensation in the anus – typically resulting from painful pressure
- Severe pain – a symptom that occurs in hemorrhoids blocked by a blood clot
- Hard lumps in the anal area – another symptom of thrombosis
Hemorrhoid causes vs rectal prolapse causes
The causes of hemorrhoids and rectal prolapses also differ. However, again, there is some overlap.
Causes of rectal prolapse include:
- Schistosomiasis and some other parasitic infections
- Back injuries, particularly in the lower back
- A history of constipation
- Straining at stool
- Congenital weakness or hereditary susceptibility
- Conditions that increase intraabdominal pressure, including chronic obstructive pulmonary disorder and enlargement of the prostate
- Age-related weakening of the anal muscles and surrounding structures, including pelvic floor muscles
- Damage to the ligaments that hold the rectum in the correct position, relative to the surrounding bones
Causes of hemorrhoids include:
- Straining when going to the toilet
- Sitting for long periods
- Being overweight or having a history of obesity
- Chronic constipation and diarrhea
- Spending a long time sitting on the toilet
- Eating too little fiber
- Becoming pregnant leading to an increase in intra-abdominal pressure
Diagnosing rectal prolapse vs diagnosing hemorrhoids
Doctors can sometimes struggle to tell the difference between rectal prolapse and hemorrhoids, even after visual examination. Therefore, they use a range of additional techniques.
A digital rectal exam is the simplest and quickest procedure. Here, a physician puts on a glove, greases their finger, and then inserts it into the rectum. They then ask you to contract your anal muscles to see if they can detect any abnormalities. If there is an issue with the bowel wall, then prolapse is more likely. If they can feel nodule-like protrusions, then hemorrhoids are more likely.
Failing that, they might use anal manometry. Here, they insert a small tube into the anus and then expand it. The pressure it exerts indicates the tightness of the anal sphincter. If the sphincter remains tight during the procedure, then hemorrhoids are the most likely diagnosis.
Fortunately, there are various home remedies for hemorrhoids. A high fiber diet, soaking in a warm bath, and using ointments, like witch hazel, can all help. You can also ask for medications, such as creams and suppositories that reduce pain. Certain minimally-invasive procedures are also available, such as rubber band ligation and injection sclerotherapy (which causes veins to shrivel up and flake off).
By contrast, rectal prolapse usually requires surgery. Stool softeners and suppositories only manage symptoms.
When to see a doctor?
If you have either anal prolapse or hemorrhoids, you can get immediate support from an online doctor. Both conditions are manageable and treatable with the right approach.
- Hemorrhoids are nodule-like sections of blood vessels that protrude either internally on the rectal wall, or externally through the anus
- Rectal prolapse involves the entire lower bowel section protruding through the anus
- Hemorrhoids rarely cause incontinence, but it is common in patients with rectal prolapse
- Home remedies and over-the-counter medications may work for hemorrhoids, but rectal prolapse typically requires surgery
- Riss, S., Weiser, F.A., Schwameis, K. et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis 27, 215–220 (2012). https://doi.org/10.1007/s00384-011-1316-3
- Alonso-Coello, Pablo1; Mills, Ed2; Heels-Ansdell, Diane2; López-Yarto, Maite3; Zhou, Qi2; Johanson, John F.4; Guyatt, Gordon2. Fiber for the Treatment of Hemorrhoids Complications: A Systematic Review and Meta-Analysis. American Journal of Gastroenterology: January 2006 – Volume 101 – Issue 1 – p 181-188. Available from: https://journals.lww.com/ajg/Abstract/2006/01000/Fiber_for_the_Treatment_of_Hemorrhoids.30.aspx
- Kim, DS., Tsang, C.B.S., Wong, W.D. et al. Complete rectal prolapse. Dis Colon Rectum 42, 460–466 (1999). https://doi.org/10.1007/BF02234167
- Brisinda G. How to treat haemorrhoids. Prevention is best; haemorrhoidectomy needs skilled operators. BMJ 2000; 321 :582 doi:10.1136/bmj.321.7261.582
- Andreia Albuquerque. Rubber band ligation of hemorrhoids: A guide for complications. World J Gastrointest Surg. 2016 Sep 27; 8(9): 614–620. doi: 10.4240/wjgs.v8.i9.614
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