Rectal prolapse can often be confused for hemorrhoids and vice versa. Know the causes and symptoms for each condition so you can get the right treatment.
Many things could cause people to have blood in their stool. This can be very freighting when it is discovered wiping after going to the bathroom. While it can signal serious health problems, it also could be a minor problem that fixes itself.
Here’s a question I frequently get from women who come to my practice, “Is this blood due to hemorrhoids or rectal prolapse?” So in this blog, I will look at hemorrhoids and rectal prolapse as two options that can cause blood in stool and share how you can learn to tell the difference.
The easiest way to be able to differentiate the two is learning about causes and symptoms and seeing where your situation fits. Hemorrhoids are much more common than rectal prolapse. That’s very beneficial to know for someone with rectal prolapse, since treatments are much different and there are no home treatment options for rectal prolapse.
My specialty is colon and rectal surgery, and I offer treatment for patients with either of these conditions. If blood in your poop at any age does not resolve on its own, or if there are sudden changes in the poop, you should bring it to a doctor’s attention. Testing, most often a colonoscopy, should be done to rule out cancer, polyps or any other possible colonic causes of bleeding.
What is a hemorrhoid?
Hemorrhoids are swollen veins in your anus (external hemorrhoids) and lower rectum (internal hemorrhoids). These may also be referred to as piles.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, hemorrhoids affect about 1 in 20 Americans.
You are at a higher risk for hemorrhoids if you:
- Strain while pooping.
- Sit on the toilet for long periods of times.
- Are over the age of 50.
- Have chronic diarrhea or constipation.
- Have a diet low in fiber.
- Often lift heavy objects.
- Are pregnant.
External and internal hemorrhoids have different symptoms. Each person will not experience each symptom, but the following are the most common.
External hemorrhoids symptoms include
- Pain or discomfort.
- Itching or irritation in the anal region.
- Swelling around the anus.
Internal hemorrhoids symptoms include
- Straining or irritation when passing stool.
- Painless bleeding during or after pooping.
- If the hemorrhoid is protruding through the anal opening, it could cause pain or irritation.
Luckily there are multiple at-home treatment options for hemorrhoids that can lead to relief.
Common at-home treatments include:
- Eating foods that are high in fiber.
- Taking stool softeners.
- Increasing the amount of water you drink.
- Not straining while going to the bathroom.
- Not sitting on the toilet for long periods of time.
- Sitting in a tub of warm water.
- Using over-the-counter hemorrhoid creams.
You should go to your doctor if your symptoms do not improve after one week. Your doctor will assess the situation, and treatments could include the following options.
In-office treatments that cut off blood supply, causing hemorrhoids to shrivel & fall off:
- Rubber band ligation – using a special rubber band to cut off the blood supply.
- Sclerotherapy – a solution is injected into the hemorrhoid causing scar tissue to form that cuts off blood supply.
- Infrared photocoagulation – heat created by an infrared light causes scar tissue to form.
- Electrocoagulation – electrical current is used to cause scar tissue.
Surgery (completed under anesthesia):
- Hemorrhoidectomy – removal of hemorrhoids that do not respond to other treatment options.
- Hemorrhoid stapling – a special stapling tool is used to remove internal hemorrhoid tissue and pull prolapsing internal hemorrhoids back into the anus.
What is rectal prolapse?
Prolapse means that a body part has fallen down or slipped from its normal position. Rectal prolapse occurs when all or part of the rectum (the last part of your large intestine) drops down inside the body or outside the anus.
A rectal prolapse will feel like you have something sticking out of the anus. Typically, you will first experience this after pooping and the rectum may return inside on its own. As time progresses, it will be harder for the rectum to go inside and it will stay outside the anus.
The American Society of Colon and Rectal Surgeons mentions that rectal prolapse affects a relatively small number of people. Only .0025% of Americans will experience this.
Rectal prolapse can be caused by:
- Long-term constipation or diarrhea.
- History of having to strain while pooping.
- Aging (especially for those over 50), which weakens ligaments and muscles in the rectal area.
- Nerve damage that affects your muscles’ ability to tighten or loosen.
- Injury to the anal or hip area.
- A consequence of cystic fibrosis, diabetes, hysterectomy, infection of the intestines, chronic obstructive pulmonary disease or other diseases that result from poor nutrition or difficulty digesting foods.
Rectal prolapse symptoms
Symptoms of rectal prolapse include:
- Feeling a bulge outside of the anus.
- Seeing a red mass outside the anal opening.
- Bleeding from the rectum.
- Pain in the rectum or anus.
- Leaking poop, blood or mucus from the anus.
Treatment for rectal prolapse
Surgery is a common treatment to correct rectal prolapse. It can be done to remove part of the rectum or to restore the rectum to the ideal location and anchor it in place. These can be done in an open or minimally invasive approach.
So is blood in your stool from a hemorrhoid or rectal prolapse?
I repeat, it is much more likely to be a hemorrhoid than rectal prolapse, considering the number of people who have each condition. But if it is rectal prolapse, it is important to know that since treatments for the two conditions do differ considerably.
While at home, the easiest way to learn what is causing bleeding is looking at the stool and considering symptoms. While some symptoms are similar in both conditions, there are signs that make it clear the condition is a hemorrhoid or rectal prolapse.
You can examine the blood in your stool by looking in the toilet bowel or the toilet paper after wiping. This may look like bright blood or be a darker, dried blood color.
If you are unsure about what your condition is, seek a doctor’s help. The doctor will ask for your medical history and perform a physical exam. While these are two possible causes, there are also many other causes your doctor can explore with you.
Patients with hemorrhoids can often be treated by their primary care provider. But when surgery is needed to solve the problem, I am here with the skills for the complex cases. For those with rectal prolapse it is best to start with a specialist, like myself, to get the needed care. My patients and I work together to identify the cause and find the best treatment options for them.