Haemorrhoids (piles) vs rectal prolapse: knowing the difference

Haemorrhoids (commonly referred to as piles) and rectal prolapse are two different problems with very similar symptoms and causes. This makes it tough for you to determine which condition is the cause of your discomfort, but fortunately, medical specialists, such as Mr Charles Evans, have the knowledge and tools to give you a diagnosis. Once diagnosed, you’ll be advised about treatment, which differs greatly between the two conditions.

What exactly are these two conditions?

Symptoms are very much the same, but the treatment requirements are different. Your treatment will depend on which condition you have.

Haemorrhoids are dilatations of the normal haemorrhoidal cushions. Everybody has haemorrhoids, but a problem becomes present when the haemorrhoids dilate and enlarge. The severity of the condition is defined by the extent to which they dilate and prolapse out of the anus.

Rectal prolapse is a condition in which the rectum loses its normal attachment that keeps it inside the body, consequently causing it to slide out through the anus. A full-thickness rectal prolapse is when the entire rectal wall falls out.

What are the symptoms of these two conditions?

Haemorrhoids and rectal prolapse share potential symptoms:

• Rectal bleeding (blood in stool)
• Prolapsed tissue outside the anus
• Mucus discharge
• Perianal discomfort
• Constipation and straining
• Diarrhoea

As neither condition has symptoms specific to it, it’s difficult for a patient to determine which is the cause. For this reason, it’s important to visit a medical specialist.

What causes them?

The two conditions share similarities when it comes to causes. Both are often caused by severe straining from chronic constipation. They can be caused in women after straining from giving birth vaginally multiple times. One slight difference is that rectal prolapse is more likely to be caused only by labour, whereas haemorrhoids can be found during both pregnancy and labour. In other cases, haemorrhoids and rectal prolapse can be associated with abnormal masses within the pelvis.

How is each condition diagnosed?

When examined in a clinic by a medical professional, they will appear different, but these are subtle differences that are related to the folds of the prolapsed tissue. Sometimes, differences are so subtle that a colorectal expert is required to determine whether haemorrhoids or rectal prolapse is the source of the problem.

Endoscopic procedures, such as the sigmoidoscopy and colonoscopy are recommended for the assessment of both conditions. These procedures involve inserting a tube through the anus and the tube has a light that is connected to a video camera and a monitor. By performing these, specialists can visualise the bowel upstream and as a result, discover any missing symptoms such as polyps.

If you are diagnosed with rectal prolapse, you might be recommended to have an additional assessment called a defecating proctogram. This is an examination of your pelvic floor which evaluates your ability to defecate.

Is treatment the same for both?

For haemorrhoids, conservative measures such as diet and lifestyle changes are critical. Haemorrhoid treatment can sometimes require surgery, and this ranges from minimally invasive to formal surgical excision

• Rubber band ligation – a band is tied around the base of a haemorrhoid to stop blood flowing into it.
• Haemorrhoidal artery ligation – blood flow is cut off from a haemorrhoid via sutures (stitches).
• Haemorrhoidectomy – this is the surgical removal of haemorrhoids and is only reserved for the most severe cases.

For a full-thickness rectal prolapse, the only definitive treatment is surgery. This can either be performed by an operation through the abdomen pulling the bowel back up inside (a rectopexy operation) or operating externally on the prolapse from the bottom end. The abdominal surgery can be performed through open surgery or ideally as a laparoscopic (keyhole) operation. The choice of surgery will be dependent on many factors, including general health and any previous surgery.

Mr Charles Evans is a leading general surgeon and one of the few UK surgeons who are specially trained in robotic surgical techniques. Visit Mr Evans’ profile to book a consultation.