Are Rectal Prolapse and Hemorrhoids the Same?

Rectal prolapse and hemorrhoids may share similar symptoms, but they are distinct conditions that require different treatments. Misdiagnosis can lead to improper treatment and serious consequences. To differentiate between rectal prolapse and hemorrhoids, consider the following information:

1. Understanding Rectal Prolapse and Hemorrhoids

Rectal prolapse occurs when the rectum, the end of the large intestine before it reaches the anus, loses its normal attachment and protrudes through the anal opening.

While this condition is benign and rarely leads to severe complications, it causes discomfort and negatively impacts daily activities. In some cases, if the prolapse becomes stuck outside the anus, it can cause strangulation and the risk of tissue necrosis.

Hemorrhoids, on the other hand, result from the excessive dilation of blood vessels in the tissues surrounding the anus. This dilation leads to the formation of hemorrhoids.

Hemorrhoids can be classified into three types based on their location: internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids.

2. Distinguishing Between Rectal Prolapse and Hemorrhoids

Prolapse Characteristics

Hemorrhoids: The prolapsed mass typically consists of the mucosal layer. It is usually short and can have one or more irregular tufts.

Rectal prolapse: The prolapsed mass involves part or all of the rectum. It appears long and round in a concentric circle. This mass secretes a significant amount of moist mucus.

Bleeding during Bowel Movements

Initially, the bleeding is usually minimal, with blood sticking to the stool or appearing on toilet paper. In the later stages, as hemorrhoids swell, bleeding can increase and may even drip or spurt.

Rectal prolapse: Bleeding also occurs during bowel movements with rectal prolapse. The blood is bright red, and the bleeding is typically minimal, often mixing with the stool. 

For an accurate diagnosis of rectal prolapse, it is recommended to rely on imaging methods in addition to considering the prolapse and bleeding characteristics.

• Video-proctoscopy: This non-invasive imaging technique provides visual evidence during bowel movements, enabling doctors to accurately diagnose rectal prolapse and differentiate it from other conditions such as hemorrhoids.
• Dynamic magnetic resonance imaging (MRI Dynamic defecography): This precise method offers high accuracy and allows for the diagnosis of associated conditions like genital prolapse and bladder prolapse. MRI also helps identify anatomical features of rectal prolapse, such as anal dilation, levator ani muscle enlargement, and downward hanging of the pouch of Douglas.

3. Prevention and Treatment of Rectal Prolapse

Preventing Rectal Prolapse

• Maintain proper hydration by drinking an adequate amount of water (about 2 liters per day).
• Increase fiber intake through fruits, vegetables, and whole grains.
• Consume foods with natural laxative effects, such as potatoes and spinach.
• Establish regular bowel movements without straining excessively.

Treating Rectal Prolapse

Different surgical methods exist based on various principles, and they can be categorized into two main groups: abdominal surgery and perineal surgery. These surgeries aim to prevent recurrent rectal prolapse and significantly improve the patient's quality of life.

The choice of surgical procedure depends on factors such as the patient's age, gender, defecation function, history of previous surgery, comorbid conditions, the degree of rectal prolapse, potential effects on bowel function and incontinence, complication and recurrence rates, and the surgeon's experience.

Additionally, rectal mucosal prolapse can be treated with the minimally invasive Longo procedure, which aims to reduce invasiveness, complications, and provide positive treatment outcomes.