Hemorrhoids vs. Rectal Prolapse: Symptoms and Treatment Options

Hemorrhoids? Rectal prolapse?

Hello, Doctor You:
I have experienced symptoms similar to hemorrhoids since childhood, where they protrude during bowel movements.
This has been ongoing for over 20 years, and sometimes there is bleeding.
After bowel movements, I can push them back in.
I have visited several clinics for examination, where they used suction to remove them.
Some diagnoses indicated hemorrhoids, while others suggested rectal prolapse and advised me to undergo surgery at a larger hospital.
I later went to Chung-Hwa Medical University for an examination, where the doctor used a cup-shaped hollow instrument to inspect the rectal wall and stated that everything appeared normal, but did not suction out any "hemorrhoids." The doctor then advised me to perform Kegel exercises regularly.

I am still unclear whether my symptoms are due to rectal prolapse or hemorrhoids.
The symptoms sometimes swell and sometimes shrink, and I experience bleeding approximately every 2 to 7 days.
What treatment should I pursue? Recently, I have been using hemorrhoid ointment for about three weeks, but I have noticed itching around the anus.
Is this normal?

Iven, 20~29 year old female. Ask Date: 2005/09/02

Dr. You Bailing reply Surgery

Severe hemorrhoids can lead to rectal prolapse.
However, since the physician at Chung Rong has found no signs of prolapse, this should be considered quite reliable.
I believe it is highly likely that you have hemorrhoids.
I recommend taking warm sitz baths, avoiding constipation, maintaining a normal lifestyle, and not staying up late.

Reply Date: 2005/09/02

More Info

Understanding the differences between hemorrhoids and rectal prolapse is crucial for effective diagnosis and treatment. Both conditions can present with similar symptoms, but they have distinct underlying causes and treatment options.

Hemorrhoids
Hemorrhoids are swollen veins in the lower rectum and anus, akin to varicose veins. They can be classified into two types: internal and external. Internal hemorrhoids are located inside the rectum and are usually not visible, while external hemorrhoids are located under the skin around the anus and can be seen and felt.

Symptoms of Hemorrhoids:
- Pain or discomfort, especially during bowel movements
- Bleeding during bowel movements, which may appear as bright red blood on toilet paper or in the toilet bowl
- Swelling or a lump near the anus
- Itching or irritation in the anal region
Treatment Options for Hemorrhoids:
1. Lifestyle Changes: Increasing fiber intake, staying hydrated, and avoiding straining during bowel movements can help alleviate symptoms.

2. Topical Treatments: Over-the-counter creams and ointments, such as hydrocortisone or witch hazel, can reduce inflammation and discomfort.

3. Sitz Baths: Soaking the anal area in warm water can provide relief.

4. Minimally Invasive Procedures: If symptoms persist, procedures like rubber band ligation, sclerotherapy, or infrared coagulation may be recommended.

5. Surgery: In severe cases, hemorrhoidectomy may be necessary to remove the hemorrhoids.

Rectal Prolapse
Rectal prolapse occurs when the rectum protrudes through the anus. This condition can happen due to weakened pelvic muscles and connective tissues, often resulting from chronic straining, childbirth, or aging.

Symptoms of Rectal Prolapse:
- A visible bulge or protrusion from the anus, especially during bowel movements
- The sensation of incomplete bowel evacuation
- Mucus discharge or bleeding
- Pain or discomfort in the anal area
Treatment Options for Rectal Prolapse:
1. Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises like Kegels can help manage mild cases.

2. Dietary Changes: Increasing fiber intake can help prevent constipation and reduce straining.

3. Surgical Intervention: In most cases, surgery is required to correct rectal prolapse. Surgical options may include rectopexy (fixing the rectum in place) or resection (removing the prolapsed section).

Distinguishing Between the Two
Given your symptoms of protrusion during bowel movements, occasional bleeding, and the ability to push the protrusion back in, it is essential to differentiate between hemorrhoids and rectal prolapse. The fact that you have experienced these symptoms for over 20 years and have had varying diagnoses suggests a need for a thorough evaluation by a specialist, preferably a colorectal surgeon.

Current Treatment and Concerns
You mentioned using a topical treatment (痔莫軟膏) for about three weeks, which has led to anal itching. Itching can be a common side effect of topical treatments, especially if they contain steroids or if there is irritation from the application. However, if the itching persists or worsens, it would be advisable to consult your healthcare provider for alternative treatments or to rule out other conditions.

Conclusion
In summary, while both hemorrhoids and rectal prolapse can cause similar symptoms, they are distinct conditions that require different management strategies. It is crucial to have a comprehensive evaluation to determine the exact nature of your symptoms and to discuss the most appropriate treatment options with your healthcare provider. Regular follow-ups and possibly a referral to a specialist may be necessary to ensure proper management of your condition.

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