Rectal Prolapse Vs. Hemorrhoids: What’s The Difference?

Rectal prolapse and hemorrhoids are medical conditions that affect the rectum. While similarities exist, differences between them can also be identified. Knowing these differences is important as it can affect the recommended treatment and outlook of the condition.

Rectal prolapse vs. hemorrhoids

Rectal prolapse and hemorrhoids differ in the presentation, symptoms, causes, and treatment of the disease.

What is rectal prolapse?

Rectal prolapse occurs when the lowest section of the large intestine (the rectum) slips out through the anus. This happens because it loses its normal attachment, which is important for keeping it in place. 

Rectal prolapse can be partial (which involves the lining of the rectum) or complete (which involves the entire wall of the rectum). 

Rectal prolapse is rare, affecting 2.5 in 100,00 people.¹

What are hemorrhoids?

Hemorrhoids are swollen and inflamed veins in the rectum and anus. 

Although the condition differs from rectal prolapse, internal hemorrhoids can prolapse when they are particularly large and bulge outwards, potentially causing symptoms similar to prolapse. 

Hemorrhoids can be external if they develop in the skin under the anus or internal if they develop inside the rectum. 

Hemorrhoids are common; up to 75% of all American people experience them at some point in their life.²

What causes rectal prolapse vs. hemorrhoids?

Rectal prolapse and hemorrhoids have similar causes. 

Rectal prolapse

Rectal prolapse occurs when the muscles become weak and cannot hold the rectum in place due to conditions that pressure the abdomen. 

This can happen due to the following causes and risk factors:

• Older age, with people over the age of 50 experiencing the condition commonly

• Being a woman, with between 80–90% of adults with rectal prolapse are women 

• Pregnancy and childbirth

• Pelvic injuries or pelvic surgery, especially where damage to the nerves or spinal cord occur

• Chronic constipation or diarrhea

• Medical conditions like cystic fibrosis and intestinal parasite infections

• Chronic coughing, sneezing, or whooping cough 

• Structural defects in the pelvis or lower gastrointestinal tract, such as having weak pelvic floor muscles or anal sphincters

• Having multiple vaginal birth deliveries

Hemorrhoids

The causes and risk factors of hemorrhoids also include conditions or situations that put strain or pressure on the veins around the anus. 

These may include:

• Straining during bowel motions — the main cause of hemorrhoids 

• Pregnancy, as the fetus puts pressure on the anal region

• A low-fiber diet

• Chronic constipation and diarrhea 

• Older age, usually over the age of 50, due to weakening and stretching of the veins 

• Lifting heavy objects

• Having anal intercourse 

Symptoms

The symptoms of rectal prolapse and hemorrhoids are similar. 

Rectal prolapse

Symptoms of rectal prolapse can include:

• Bulging or pressure in the anus 

• Feeling as if something is left behind in the anus after passing a bowel

• A red, fleshy mass sticking out of the anus

• Itching or pain in the anal area

• Blood, mucus, or feces leaking from the anus 

• Constipation and/or diarrhea 

• Inability to control bowel movements (fecal incontinence) 

Hemorrhoids

Symptoms of hemorrhoids can include:

• An itchy or painful anus, especially when sitting

• Hard, sore, and tender lumps near the anus

• Rectal bleeding 

Someone with external hemorrhoids may be more likely to experience these symptoms. Internal hemorrhoids are often painless, asymptomatic, and sometimes not noticeable unless they prolapse.

How are the two conditions diagnosed?

Getting a diagnosis of either hemorrhoids or rectal prolapse is important. This is because rectal bleeding can indicate a more severe condition, such as cancer or Chrons’ disease. 

A doctor can differentiate between rectal prolapse and hemorrhoids through visual examination, as differences between the two conditions exist in the mucosal folds. Usually, they’re circular for rectal prolapse and radial for hemorrhoids. 

Diagnosing rectal prolapse

Some ways that rectal prolapse can be diagnosed include:

• A physical examination of the anus, allows the doctor to see if any prolapse is present

• Demonstration of a straining movement to the doctor, which involves squeezing and relaxing the anal sphincter

• A digital rectal exam, is where the doctor inserts a gloved finger into the rectum to feel for abnormalities

• A defecography, which uses X-rays or magnetic resonance imaging (MRI) to look at the functioning and structural changes of the muscles and organs while passing a bowel motion

• A colonoscopy, is a procedure that involves passing a long, flexible, thin tube with a small camera through the anus and into the rectum and colon

• An anal manometry, which involves passing a catheter with a probe into the rectum to see how well the rectum and anal sphincters work to remove feces

Diagnosing hemorrhoids can include:

• A digital rectal exam

• Visual inspection, where the doctor checks for lumps, swelling, prolapsed hemorrhoids, leaking mucus or feces, external hemorrhoids, and skin irritation

• Anoscopy, which involves inserting a small, rigid tube into the anal canal to look at the lining of the anus and rectum

• Colonoscopy for visualizing internal hemorrhoids, especially if the patient has other risk factors or signs and symptoms of another disease

Treatment of rectal prolapse vs. hemorrhoids

Among the most significant differences between rectal prolapse and hemorrhoids is treatment options and how they’re managed.

Rectal prolapse

Unlike hemorrhoids, rectal prolapse is unlikely to resolve on its own. Dietary and lifestyle changes also often aren’t enough to treat it.

The amount of prolapse can enlarge over time. This can cause complications such as fecal incontinence, rectal ulcers, and an incarcerated rectum (where the prolapse becomes trapped and strangled outside the anus).

Surgery is often recommended for rectal prolapse. This can be:

• Abdominal-based rectopexy, which involves going through the lower abdomen to pull the rectum back into position

• Perineal surgery, which involves going through the anal canal and is better for older adults or people with other medical conditions

Some other ways that rectal prolapse can be managed include:

• Stool softeners

• Suppositories

• Other medications

Hemorrhoids

Fortunately, complications of hemorrhoids are rare. Treatment is mainly designed to reduce symptoms and manage the condition. 

In many cases, dietary and lifestyle modifications are enough to treat hemorrhoids, and they can often improve within a week.

Ways to treat hemorrhoids include:

• Drinking more water

• Increasing fiber intake. Fruits, vegetables, and whole grains are good sources of dietary fiber. If needed, fiber supplements can also help.

• Taking a sitz bath. This is a type of shallow hip bath that you sit in for 10–15 minutes two to three times a day. It can help reduce pain and itching. 

• Taking medications, such as pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin, and creams containing lidocaine, witch hazel, or hydrocortisone

• Laxatives to prevent constipation and soften the stool 

People who have severe and painful hemorrhoids may be offered surgery, such as:

• Rubber band ligation, where the surgeon places a rubber band around hemorrhoid, causing it to lose blood supply and fall off

• Hemorrhoidectomy, which involves removing the hemorrhoids

Prevention

While rectal prolapse and hemorrhoids can’t always be prevented, the risk of developing both conditions can be reduced.

Ways to prevent hemorrhoids include:

• Increase fiber intake: It’s recommended to eat 20–30 grams of fiber each day or take fiber supplements if needed. This can help prevent constipation. 

• Increase fluid intake: Try drinking eight glasses of water and nonalcoholic beverages daily. This can help prevent constipation. 

• Avoid straining and sitting on the toilet for too long during bowel movements. Try to go to the toilet as soon as you need to.

• Increase physical activity, which can help prevent constipation.

Ways to prevent rectal prolapse from recurring or occurring after the surgery, in addition to increasing fiber and fluid intake, include:

• Treat chronic bowel disorders like constipation, diarrhea, and any persistent cough. 

• Carry out exercises that strengthen the pelvic floor. 

• Avoid activities that put pressure on the abdomen for six months. 

The lowdown

Rectal prolapse and hemorrhoids are similar rectal conditions; however, they can be differentiated.

If you think you may have rectal prolapse or hemorrhoids, it’s important to see your doctor. When diagnosed early, both hemorrhoids and rectal prolapse can be fully treatable. 

Frequently asked questions

Can hemorrhoids look like rectal prolapse?

Hemorrhoids can look like rectal prolapse. This is mainly because hemorrhoids can prolapse if they stretch and bulge outside the anus. 

What is the difference between rectal prolapse and piles?

Rectal prolapse is when the rectum slips out of its normal position and slides through the anus. Piles (hemorrhoids) are when the veins in the anus and lower rectum become swollen and inflamed.

How do you tell if a hemorrhoid is prolapsed?

Prolapsed hemorrhoids typically bleed and cause pain. You may also notice a lump bulging outside of the anus that you can sometimes push back inside. To determine whether the hemorrhoid has prolapsed, it’s a good idea to see your doctor as soon as possible.³