Discomfort, pain, and bleeding in the rectal area often lead people to suspect hemorrhoids. While hemorrhoidal disease is a frequent cause of these symptoms, it is not the only one. Distinguishing this condition from rectal prolapse is important, as prolapse involves a different structure and requires a distinct treatment approach. Understanding these differences is necessary for an accurate diagnosis and appropriate medical care.
Defining Hemorrhoids and Rectal Prolapse
Hemorrhoids are swollen, inflamed vascular structures located in the anal canal and lower rectum. These structures, known as anal cushions, naturally aid in stool continence. When the blood vessels within these cushions become enlarged, they become symptomatic hemorrhoids, which can be internal or external.
Rectal prolapse is a structural failure where the rectum loses its normal attachments and slides out of place. This involves the protrusion of the actual rectal wall through the anus, similar to a sock turning inside out. Severity ranges from a mucosal prolapse (only the lining) to a full-thickness prolapse (the entire wall). The distinction is that hemorrhoids involve swollen blood vessels, while prolapse is the displacement of the intestinal wall itself.
Visual and Symptomatic Distinctions
The visual appearance of the protruding tissue offers a significant clue for telling the two conditions apart. Prolapsed hemorrhoids typically look like distinct, irregular lumps or clusters that are often purplish or dark red, especially if thrombosed. Conversely, a full-thickness rectal prolapse presents as a larger, uniformly rounded mass of tissue with concentric circular folds radiating from the center. This prolapsed tissue is usually pink or red, resembling the intestinal lining, and often secretes a noticeable amount of mucus.
The way the protruding tissue behaves is also different, particularly regarding reducibility. Smaller, prolapsed internal hemorrhoids may retract spontaneously after a bowel movement or can be easily pushed back inside. A rectal prolapse, especially a complete one, often requires manual assistance to be pushed back and may immediately reappear upon standing or straining. In severe cases of prolapse, the tissue may become permanently irreducible, meaning it cannot be manually returned to its proper position.
Pain and the nature of bleeding also help differentiate the two conditions. Internal hemorrhoids are typically painless because they originate in an area with few nerve endings; the primary symptom is bright red blood separate from the stool. Pain occurs only if the internal hemorrhoid prolapses and spasms, or if an external hemorrhoid becomes thrombosed. Rectal prolapse generally causes a sensation of incomplete evacuation, rectal pressure, fullness, and potential fecal incontinence. Bleeding from a rectal prolapse is usually less pronounced and is often mixed with mucous discharge.
Why They Happen
The underlying causes for these two conditions are distinct, reflecting the difference in the affected anatomical structures. Hemorrhoids are primarily caused by chronic increased pressure within the anal cushions. This pressure is commonly linked to repeated straining during bowel movements due to chronic constipation, prolonged sitting, and conditions that increase intra-abdominal pressure like pregnancy or obesity. The constant strain engorges the blood vessels and weakens the supporting connective tissue, allowing the cushions to swell and prolapse.
Rectal prolapse, while exacerbated by chronic straining, is fundamentally a problem of structural weakness and detachment. It results from the weakening of the pelvic floor muscles and the ligaments that hold the rectum in its proper position. Risk factors for this structural failure include aging, a history of childbirth, previous pelvic or anal surgery, and neurological issues that impair muscle control.
Seeking Medical Attention
Any persistent discomfort, bleeding, or noticeable protrusion from the anal area warrants a consultation with a healthcare professional. Self-diagnosis is unreliable because the symptoms of a prolapsed internal hemorrhoid can closely mimic those of an early mucosal rectal prolapse. A definitive diagnosis is necessary because the treatment paths for the two conditions are very different.
A doctor will typically perform a physical examination, which may include a digital rectal exam, and may ask the patient to strain to observe the protrusion. Specialized procedures like an anoscopy or sigmoidoscopy may be used to visualize the internal structures and confirm the diagnosis. While hemorrhoids often respond well to conservative treatments, rectal prolapse typically requires more intensive medical intervention. A full-thickness rectal prolapse often requires surgical correction to anchor the rectum back into its correct anatomical location and prevent recurrence.