Do I Have Hemorrhoids or Rectal Prolapse?

People often question the relationship between hemorrhoids vs. rectal prolapse. Once you understand the difference between the two, you can get a better idea of what you might be experiencing. 

What are hemorrhoids?

There are clusters of veins that lie beneath the mucous membrane lining of the lowest part of our anus and rectum. When those veins become swollen, it results in a condition called hemorrhoids. They are actually a varicose vein that forms in the rectum. 

There are two common types of hemorrhoids:   

• Internal hemorrhoids: Internal hemorrhoids are typically small, swollen veins found in the walls of the anal canal. They can sometimes grow large and bulge out of the anus. Those bulging veins can become painful if they are squeezed by your anus muscles or cut off from their blood supply. 
• External hemorrhoids: External hemorrhoids are veins beneath the skin of your rectum that get irritated and start clotting. You may feel a hard lump in that area when this happens.   

What is rectal prolapse?

Rectal prolapse is a medical condition where your rectum walls slide out of their normal position because of a loosening of their normal attachments inside your body. There are three different types of rectal prolapse:   

• Partial prolapse: Partial prolapse happens when the rectum’s mucous membrane lining slides out of position and starts protruding from the anus. A partial prolapse can occur while having a bowel movement and most commonly happens in children two years old or younger.
• Complete prolapse: Complete prolapse happens when the entire rectum wall slides out of its normal position and protrudes from the anus. You can experience a complete prolapse while having a bowel movement or when you are standing or walking. Sometimes it progresses to the point where the rectum tissue sticks out all the time. 
• Internal prolapse: Internal prolapse happens when part of the large intestine’s wall or rectum slides or moves into a different area.

There are some symptoms that hemorrhoids have in common with a rectal prolapse. However, most of the ways in which each condition manifests are quite distinct. 

Symptoms of a hemorrhoids

Some of the most common symptoms of hemorrhoids include:   

• Blood in your stool
• Pain and irritation around your anal area
• Swelling or hard lump around your anal area
• Itchiness around the anus

Symptoms of a rectal prolapse

Symptoms that typically appear in cases of a rectal prolapse include:  

• Constipation
• Itching
• Bulge in your anus after sneezing, coughing, or lifting 
• Pain and bleeding in your rectum
• Mucous discharge in your stool
• Fecal incontinence
• Pressure in your rectum  

Causes of hemorrhoids

Hemorrhoids are usually caused by strain put on the veins around the anus, often from constipation. The following factors can increase your risk of developing hemorrhoids:  

• You are currently pregnant
• You have a family history of hemorrhoids
• You have a habit of sitting on the toilet for long periods
• You are considered overweight or medically obese
• You perform tasks that cause strain in your rectum
• You have chronic constipation or diarrhea
• You are between ages 45 and 65

Causes of rectal prolapse  

In general, rectal prolapse is caused by weakening of the muscles supporting your rectum. Women are more prone to having a rectal prolapse than men. You may be at risk of having a rectal prolapse if:   

• You have a history of constipation
• You have gone through childbirth
• You have chronic diarrhea
• You overuse or abuse laxatives
• You often strain when having a bowel movement
• You have previously had a stroke
• You have spinal cord issues
• You have cystic fibrosis
• You have dementia

If you notice symptoms like blood in your stool or constant irritation around your anus, it is a good idea to see a physician. They can evaluate you and determine whether you have hemorrhoids or a rectal prolapse.

Diagnosis for hemorrhoids

Doctors typically diagnose hemorrhoids by performing a physical exam and asking you about your symptoms. They may also request additional testing like:  

• Digital rectal examination (DRE): The doctor covers their hand with a lubricated glove, then inserts their finger inside your rectum to check for issues.
• Anoscopy: The doctor inserts a hollow, lighted tube inside your anus to get a view of any internal hemorrhoids.
• Proctoscopy: The doctor places a lighted tube inside your anus to get a view of your entire rectum.
• Sigmoidoscopy: The doctor looks at part of your large intestine with a small, flexible, lighted tube that blows air into your rectum so that it swells.
• Coloscopy: This test lets the doctor see the entire length of your large intestine, which allows them to check for abnormal growths, red or swollen tissue, ulcers, or any bleeding. 

Diagnosis for rectal prolapse 

In addition to performing a physical exam, your doctor may request the following tests when checking for rectal prolapse:   

• Videofecogram: An x-ray is taken while you have a bowel movement.
• Anorectal manometry: The doctor places a tube that measures the pressure inside your rectum to determine the level of contraction in the muscles responsible for bowel movements.
• Barium enema: The doctor places a contrast solution inside your rectum before taking x-rays.

Treatments for hemorrhoids

More severe cases of hemorrhoids may require surgery. Your doctor may recommend treating milder cases of hemorrhoids with the following at-home remedies, including:   

• Sit in a bathtub full of plain, warm water several times per day.
• Place ice packs on the hemorrhoids to help with swelling.
• Apply hemorrhoid creams or inserting suppositories.
• Add more fiber to your diet.
• Take stool softeners.

Treatments for rectal prolapse

Treatments for rectal prolapse usually focus on preventing constipation and straining. Kegel exercises and stool softeners can also help. Rectal prolapse will sometimes go away on its own. However, severe cases of rectal prolapse may require surgery, such as: 

• Repair can be made through the abdomen to attach the rectum to the backbone to keep it in place.
• Repair can be made through the rectum to remove the prolapsed section.
• Some repairs combine both techniques through the abdomen and rectum.

Talk to your doctor about whether you have hemorrhoids and rectal prolapse so you can get the right treatment and relieve your pain and discomfort.