Hemorrhoids and rectal prolapse can both cause uncomfortable symptoms around the anus. However, they are distinct conditions that require different treatments. This article provides an overview of hemorrhoids and rectal prolapse, including their symptoms, causes, diagnosis, and treatment options. Read on to learn how to tell these two conditions apart.
What are Hemorrhoids?
Hemorrhoids are swollen, inflamed veins located in and around the anus and lower rectum. There are two types of hemorrhoids:
- Internal hemorrhoids occur inside the rectum and are usually painless.
- External hemorrhoids develop under the skin around the anus and can be extremely painful.
Hemorrhoids affect around 1 in 20 Americans. They are more common in adults ages 45-65 and in women during pregnancy. Hemorrhoids can develop due to:
- Chronic constipation and straining during bowel movements
- Sitting for long periods of time on the toilet
- Diarrhea
- Obesity
- Pregnancy and childbirth
- Aging
- Heavy lifting
Genetics may also play a role in developing hemorrhoids. Hemorrhoids are clusters of veins that expand and get inflamed when put under pressure. The veins may stretch and bulge, causing a range of uncomfortable symptoms.
Signs and Symptoms of Hemorrhoids
Symptoms depend on the location of the hemorrhoid and whether a clot has formed, called a thrombosed hemorrhoid. Common symptoms include:
- Painless bleeding during bowel movements
- Itching, irritation, swelling, and inflammation around the anus
- A lump near the anus, which may be sensitive or painful
- Leakage of feces
- Difficulty cleaning after a bowel movement due to prolapsed hemorrhoid
- Pain and swelling from thrombosed hemorrhoid
Symptoms are usually temporary and clear up in a few days with at-home treatment. But recurring hemorrhoids that don’t respond to treatment may indicate an underlying condition that needs medical attention.
What is Rectal Prolapse?
Rectal prolapse, also known as a rectal wall prolapse, occurs when the rectum turns itself inside out and protrudes from the anus. There are three types of rectal prolapse:
- Full-thickness rectal prolapse – all layers of the rectum protrude from the anus
- Mucosal prolapse – only the inner lining of the rectum protrudes
- Internal prolapse – the rectum telescopes in on itself but doesn’t protrude
Rectal prolapse is relatively uncommon. It affects about 2.5 out of 100,000 people and becomes more common with age. Women over 50 are at the highest risk. Causes include:
- Injury to the pelvic floor muscles
- Chronic constipation and straining during bowel movements
- Pregnancy and childbirth
- Chronic cough
- Heavy lifting
- Obesity
- Prior pelvic surgery
Weakening of the pelvic floor and damage to the tissues supporting the rectum can lead to prolapse. People with prolapse may feel the sensation of rectal pressure and fullness. Without treatment, the prolapse can gradually worsen over time.
Signs and Symptoms of Rectal Prolapse
The most obvious symptom is the protrusion of pink, red tissue from the anus. Other symptoms include:
- Feeling of pressure or fullness in the anus or lower abdomen
- Leakage of liquid or stool from the anus
- Bleeding, mucus discharge, or rectal pain
- Inability to control bowel movements
The protruding tissue may need to be manually pushed back into place after passing stool. Symptoms often worsen with physical activities like coughing or heavy lifting. Without treatment, the prolapsed tissue can become swollen and painful.
How to Tell the Difference
Despite some overlapping symptoms, hemorrhoids and rectal prolapse have distinct differences. Here’s a comparison:
| Differences | Hemorrhoids | Rectal Prolapse |
|---|---|---|
| Location | Inflamed veins around the anus or inside the lower rectum | Rectal tissue protrudes from the anus |
| Appearance | Enlarged, swollen veins that may bulge or protrude | Protrusion of the rectum itself and rectal lining |
| Pain | Painless or mildly painful | Can be very painful |
| Bleeding | Typically causes bleeding | May cause bleeding |
| Bowel control | Usually normal | Leakage and lack of control common |
| Cause | Swollen veins due to straining or pressure | Weakened pelvic floor muscles and connective tissue |
| Risk factors | Constipation, diarrhea, obesity, pregnancy, aging | Chronic straining, pregnancy, pelvic injury, aging |
The best way to determine whether it’s hemorrhoids or rectal prolapse is through an examination by a doctor. They will visually inspect the anus and perform a digital rectal exam to diagnose the cause of symptoms.
Diagnosing Hemorrhoids vs Rectal Prolapse
To diagnose the cause of anal/rectal symptoms, the doctor will:
- Ask about your symptoms, bowel habits, medical history, and family history
- Perform a visual examination of the anus and surrounding area
- Use an anoscope to view the inside of the anus and lower rectum
- Conduct a digital rectal exam by inserting a gloved, lubricated finger into the rectum
- Check for enlarged hemorrhoids or signs of prolapsed tissue
- Order additional tests if needed, such as an MRI or CT scan
Your doctor can determine whether hemorrhoids, rectal prolapse, or another condition is causing your symptoms based on the examination and test findings. Proper diagnosis guides the appropriate treatment.
When to See a Doctor
Seek medical care if you experience the following symptoms:
- Rectal bleeding
- Chronic constipation or diarrhea
- Severe pain that interferes with daily activities
- Leaking stool or inability to control bowel movements
- A bulge or protrusion from the anus
- Problems cleaning yourself after bowel movements
While hemorrhoids sometimes clear up on their own, a prolapsed rectum won’t improve without treatment. Bleeding and changes in bowel habits may indicate a more serious condition. See your doctor to determine the underlying cause and appropriate treatment.
Treatments for Hemorrhoids and Rectal Prolapse
Treatment options for hemorrhoids and rectal prolapse depend on the type, severity, and underlying cause. Some common treatments include:
Hemorrhoid Treatments
- Over-the-counter medications – Stool softeners, ointments, creams, suppositories, or pads to relieve swelling and pain.
- Procedures – Rubber band ligation, sclerotherapy injections, infrared coagulation, or electrocoagulation to shrink hemorrhoids.
- Surgery – Hemorrhoidectomy to remove severe internal and external hemorrhoids.
- Lifestyle changes – Increased fiber and fluid intake, sitz baths, avoid straining during bowel movements.
Rectal Prolapse Treatments
- Medications – Stool softeners and laxatives to reduce straining during bowel movements.
- Surgery – Rectopexy to surgically reinforce and realign the rectum.
- Pelvic floor physical therapy – Exercises to strengthen the pelvic floor muscles.
- Bowel management program – Strategies to establish regular bowel habits.
Mild prolapse can sometimes be treated nonsurgically with observation, medications, and Kegel exercises. Surgery is often required for full-thickness external prolapse. Talk to your doctor about the best treatment options for your symptoms and underlying medical conditions.
Prevention
You may be able to reduce your risk of developing hemorrhoids or prolapse by:
- Eating a high-fiber diet and staying hydrated
- Avoiding prolonged sitting on the toilet
- Treating chronic constipation or diarrhea
- Avoiding heavy lifting
- Performing Kegel exercises to strengthen the pelvic floor
- Maintaining a healthy weight
- Not straining during bowel movements
Practice good bowel habits, don’t sit on the toilet for long periods, and stay active to prevent muscle weakness in the rectum. See your doctor if you have any rectal symptoms that worry you or that persist despite home treatment.
When to Seek Emergency Care
Seek immediate medical care if you experience:
- Large amounts of rectal bleeding
- Severe pain and swelling in the rectum or anus
- A suddenly painful bulge or mass coming from the anus
- Bowel movements combined with mucus or bloody discharge
- Inability to have a bowel movement or pass gas
- Fever and chills along with rectal pain
These symptoms may indicate a serious underlying condition, such as a thrombosed hemorrhoid, infection, abscess, fissure, or nerve damage. Prompt evaluation and treatment can help prevent complications from these conditions.
Conclusion
Hemorrhoids and rectal prolapse cause similar symptoms but are distinct conditions. Hemorrhoids are swollen veins around the anus while prolapse is the protrusion of the rectum itself. Doctors diagnose the cause based on physical examination and medical history. Treatments range from over-the-counter remedies to surgical procedures, depending on severity. Seek prompt medical care for bleeding, severe pain, or changes in bowel habits to receive proper diagnosis and treatment.