Rectal prolapse vs hemorrhoids - What is the main difference?
Are you struggling with pain in your buttocks and unsure of the cause? There are many causes for anal pain, some of them will disappear with time, others will require some specific medication and others may need surgery.
Understanding Rectal Prolapse and Hemorrhoids
What are Hemorrhoids?
Hemorrhoids, or hemorrhoidal veins, are a normal part of human anatomy, serving three main functions:
- Closing the anal canal during high abdominal pressure, being part of the complex continence system
- Providing sensory information to distinguish stool, liquid, and gas
- Protecting the anal sphincter muscles
However, when these veins swell or dilate, they cause pain and discomfort, a condition known as hemorrhoidal disease or piles.
Types of Hemorrhoids
1- Internal Hemorrhoids: Positioned within the anal canal, these can enlarge and protrude from the anus, leading to pain when compressed or deprived of blood flow.
2- External Hemorrhoids: Found outside the anus, these can become thrombosed (clotted), leading to severe pain and inflammation.
What is Rectal Prolapse?
Rectal prolapse happens when the rectum, the final segment of the large intestine, shifts out of its usual position and extends through the anus.
Types of Rectal Prolapse
1- Partial Prolapse (Mucosal Prolapse): Only the rectum’s mucous membrane slides out.
2- Complete Prolapse: The entire rectum wall protrudes through the anus, initially during bowel movements or light activities, potentially becoming constant.
3- Internal Prolapse (AKA rectal intususception): Part of the large intestine’s wall moves into a different area without protruding externally.
Symptoms of Rectal Prolapse vs Hemorrhoids
Hemorrhoid Symptoms
- Bright red blood in stool
- Leaking feces
- Swelling or hard lump around the anus
- Protrusion during defecation
- Pain or soreness when sitting
- Itching, inflammation, and irritation around the anus
- Mucus discharge
- Sensation of incomplete bowel evacuation
- Painless bleeding
Rectal Prolapse Symptoms
- Constipation or difficulty for defecation
- Anal pain, itching, and bleeding
- Bulging anus after sneezing, coughing, or lifting
- Mucus in stool
- Bowel incontinence
- Rectal pressure
Causes of Hemorrhoids and Rectal Prolapse
Causes of Hemorrhoids
- Pregnancy
- Family history of hemorrhoids
- Prolonged standing or sitting, especially on the toilet
- Overweight or obesity
- Heavy lifting
- Chronic constipation or diarrhea
- Aging (more common in people over 30)
- Low-fiber diet
- Stress
Causes of Rectal Prolapse
- Pregnancy and childbirth
- Chronic diarrhea or constipation
- Overuse of laxatives
- Straining during bowel movements
- Stroke history
- Neurological problems (e.g., spinal cord issues)
- Weak pelvic floor muscles
- Previous injuries to the anal, lower back, or pelvic area
- Nerve damage
- Lumbar disk disease
- Conditions increasing abdominal pressure (e.g., COPD)
Diagnosing Hemorrhoids and Rectal Prolapse
Diagnosis of Hemorrhoids
Doctors typically use a Digital Rectal Examination (DRE), inserting a lubricated glove finger into the rectum to detect issues. Additional tests may include anoscopy, proctoscopy, sigmoidoscopy, and colonoscopy to view the anus, rectum, or colon with a small camera.
Diagnosis of Rectal Prolapse
Diagnosis involves reviewing medical history and conducting a physical examination. Imaging tests may identify pelvic floor dysfunctions and determine the best treatment.
Such as video ecogram, anorectal manometry, barium enema, anal electromyography (EMG), anal ultrasound, pudendal nerve terminal motor latency test, defecography, proctosigmoidoscopy, colonoscopy, and dynamic MRI.
Treatment of Rectal Prolapse vs. Hemorrhoids
Rectal prolapse and hemorrhoids, while both affecting the rectal area, have distinct differences in treatment options and management.
Rectal Prolapse
Management and Treatment: Rectal prolapse typically requires more intensive intervention and does not resolve independently. Dietary and lifestyle changes are usually insufficient for treating this condition, however when there is a clear trigger cause, this should be addressed and solved before any surgery is considered.
Complications
- Fecal incontinence
- Rectal ulcers
- Incarcerated rectum (where the prolapse becomes trapped and strangulated outside the anus)
Surgical Options:
1- Abdominal-based Rectopexy: This procedure involves accessing the lower abdomen to reposition the rectum.
2- Perineal Surgery: This less invasive method involves accessing the rectum through the perineum and is often preferred for older adults or those with other medical conditions.
3- Other Management Methods:
- Stool softeners
- Suppositories
- Medications
Hemorrhoids
Management and Treatment: Hemorrhoids generally have less severe complications and often respond well to conservative treatments. With appropriate care, symptoms usually improve within a week.
1- Non-Surgical Treatments:
- Hydration: Consuming ample amounts of water aids in preventing constipation.
- Fiber Intake: Increasing fiber through fruits, vegetables, whole grains, or supplements can aid in bowel movements.
- Sitz Baths: Sitting in a shallow bath for 10-15 minutes, two to three times daily, can alleviate pain and itching.
- Medications: Using pain relievers like NSAIDs (ibuprofen, aspirin) and topical treatments containing lidocaine, witch hazel, or hydrocortisone can reduce symptoms.
- Laxatives: To prevent constipation and soften stools.
2- Surgical Options:
- Rubber Band Ligation: During a minimally invasive procedure, a small rubber band is used to shrink an internal hemorrhoid by restricting blood flow.
- Laser Hemorrhoidoplasty: the root of the hemorrhoid is coagulated with laser energy, interrupting the blood flow inside the hemorrhoid
- Doppler-guided Hemorrhoidal Dearterialization: with the help of a Doppler ultrasound, the arteries giving flow to the hemorrhoidal cushions are located and ligated
- Hemorrhoidectomy: In this procedure the hemorrhoids are surgically removed.
Difference between Rectal Prolapse and Hemorrhoids
Here’s a table summarizing the differences between rectal prolapse and hemorrhoids:
| Rectal Prolapse | Hemorrhoids | |
| Protrusion of the rectum through the anus | Swollen blood vessels in the rectum or anus | |
| Long, round mass, concentric | Small, irregular tufts, either internal or external | |
Symptoms | Bulge from the anus, mucus discharge, fecal incontinence, feeling of incomplete bowel movement | Bright red bleeding during bowel movements, itching, pain, discomfort during defecation | |
CommonCause | Chronic constipation, straining, childbirth, aging | Straining during bowel movements, prolonged sitting, pregnancy, obesity |
| Physical examination, defecography, colonoscopy, dynamic MRI | Physical examination, anoscopy, colonoscopy | |
| Dietary changes, stool softeners, pelvic floor exercises | Over-the-counter creams, sitz baths, increased fiber intake | |
| Abdominal or perineal surgery to restore rectal anatomy | Hemorrhoidectomy, laser, doppler-guided | |
| High-fiber diet, hydration, exercise, healthy bowel habits | High-fiber diet, hydration, exercise, healthy bowel habits |
Prevention
Preventing Hemorrhoids
- Increase Fiber Intake: Aim for 20-30 grams of fiber daily to prevent constipation.
- Stay Hydrated: Adequate water intake can help prevent constipation.
- Avoid Straining: Don’t strain or sit on the toilet for too long during bowel movements.
- Stay Active: To avoid constipation, incorporate physical activity into your routine.
Preventing Rectal Prolapse
In addition to increasing fiber and fluid intake:
- Treat Chronic Bowel Disorders: Address issues like constipation, diarrhea, and persistent cough.
- Strengthen Pelvic Floor Muscles: Engage in exercises that strengthen these muscles.
- Avoid Abdominal Pressure: Refrain from activities that put pressure on the abdomen for six months post-surgery.
Despite affecting the same region, rectal prolapse and hemorrhoids require distinct treatment methods. Early diagnosis is vital for both conditions. If you suspect you have either, consult Dr. Daniel Serralta in Dubai for an accurate diagnosis and appropriate treatment.
Dr. Daniel Serralta, a renowned general surgeon in Dubai, specializes in treating rectal prolapse and hemorrhoids. His comprehensive and personalized care aims to enhance your quality of life.
If you’re experiencing symptoms, don’t hesitate to seek a thorough evaluation and tailored treatment plan from Dr. Daniel Serralta.