It is common to confuse hemorrhoids and rectal prolapse because both conditions can cause similar symptoms in the rectal area. Despite shared discomforts, these are distinct medical issues with different underlying causes and appearances. Understanding the specific characteristics of each can help individuals recognize what they might be experiencing.
Understanding Hemorrhoids
Hemorrhoids are swollen veins located in the lower rectum or around the anus. Hemorrhoids are quite common, affecting about half of all people by age 50.
There are two primary types of hemorrhoids. Internal hemorrhoids form inside the rectum and do not cause pain unless they prolapse or become irritated. External hemorrhoids develop under the skin around the anus and are more noticeable, causing pain, itching, or a hard lump. Common symptoms include bright red bleeding during bowel movements, anal itching or irritation, and discomfort or a lump near the anal opening.
Understanding Rectal Prolapse
Rectal prolapse occurs when the rectum turns inside out and protrudes through the anus. This condition happens when the muscles and ligaments that normally hold the rectum in place weaken, allowing it to slide out.
The severity of rectal prolapse can vary. In a partial or mucosal prolapse, only the inner lining of the rectum protrudes, while a complete prolapse involves the entire thickness of the rectal wall. Symptoms include a sensation of a bulge or mass protruding from the anus, difficulty with bowel movements, a feeling of incomplete emptying, or leakage of stool or mucus. Initially, the prolapse may only occur during a bowel movement, but over time, it may protrude more frequently or remain outside.
Key Differences in Appearance and Sensation
Distinguishing between hemorrhoids and rectal prolapse relies on specific visual cues and the sensations they produce. While both can present as a mass protruding from the anus, their appearance and feel are distinct.
When hemorrhoids protrude, they appear as distinct, purplish or bluish, swollen lumps or cushions. External hemorrhoids may resemble grape-like clusters, and if a blood clot forms, they can be a hard, discolored lump. In contrast, a prolapsed rectum presents as a larger, reddish, fleshy mass with characteristic concentric rings, much like the layers of an onion. Hemorrhoids, especially internal ones, have radiating folds when prolapsed.
The sensations associated with each condition also differ. Hemorrhoids can cause sharp pain, itching, or a feeling of pressure, particularly if thrombosed or irritated. Rectal prolapse feels like a more substantial bulge or a sensation of sitting on a ball. Individuals with rectal prolapse may also experience a persistent urge to defecate or a feeling that the bowel has not fully emptied.
Hemorrhoids may reduce on their own or can be gently pushed back inside, especially internal ones. Rectal prolapse, depending on its severity, may require more effort to push back or may not reduce at all, potentially staying outside.
When to Seek Medical Advice
Given the shared symptoms but differing treatments, professional medical evaluation is necessary for an accurate diagnosis. Self-diagnosis can be misleading, and a healthcare provider can differentiate between these conditions through a physical examination.
Seek medical attention if symptoms persist, worsen, or cause significant discomfort. Specific circumstances requiring medical consultation include persistent rectal bleeding, especially if the toilet water turns red or large blood clots are present. Severe pain, an inability to reduce a prolapsed mass, changes in bowel habits, or any new or concerning symptoms require professional assessment.