Rectal Prolapse vs Hemorrhoids – How to Tell the Difference?

Rectal prolapse and hemorrhoids can sometimes look and feel similar. Because of this, telling the difference between them isn’t always easy.

Hemorrhoids are swollen veins located around the rectum and anus. They are common and usually result from straining during bowel movements, prolonged sitting, and dietary factors. In contrast, rectal prolapse involves the bulging out of the lower part of the large intestine through the anus.

Hemorrhoids are typically small and are located inside the rectum or just around the anus. They commonly cause symptoms such as itching, mild discomfort, and sometimes bleeding during bowel movements.

On the other hand, rectal prolapse involves the protrusion of a larger portion of the rectum through the anus, which is often visibly noticeable as a bulging mass. It usually leads to more pronounced pain and discomfort, especially when sitting or during bowel movements. Additionally, it may be accompanied by difficulties in controlling bowel movements, something not commonly associated with hemorrhoids.

Key takeaways:

  • Hemorrhoids and rectal prolapse are two different conditions, even though they may have similar symptoms.
  • Hemorrhoids are swollen veins in the rectum and anus, while rectal prolapse involves the protrusion of a larger portion of the rectum through the anus.
  • Hemorrhoids typically cause mild symptoms such as itching and discomfort, while rectal prolapse can lead to more severe pain, discomfort, and difficulties in controlling bowel movements.
  • If you notice a small area of discomfort localized to the anal region, it might be hemorrhoids. However, if there is a visible protrusion, significant pain, and issues with bowel control, it is more likely to be rectal prolapse.
  • It is essential to seek medical advice if you are unsure or experiencing persistent symptoms, as both conditions may require different treatment approaches.

Continue reading to learn more about each condition, the causes, symptoms, and treatments available, and how to tell the difference between them.

Table of Contents

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. 

Your 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 to as 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 leads 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. 

Treatment Options

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. 

Key Takeaways

  • 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

Sources:

Content on the DrHouse website is written by our medical content team and reviewed by qualified MDs, PhDs, NPs, and PharmDs. We follow strict content creation guidelines to ensure accurate medical information. However, this content is for informational purposes only and not a substitute for professional medical advice, diagnosis, or treatment. For more information read our medical disclaimer.

Always consult with your physician or other qualified health providers about medical concerns. Never disregard professional medical advice or delay seeking it based on what you read on this website.

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