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Dr QM Leong
Dr QM Leong

Haemorrhoids Vs Rectal Prolapse Vs Rectocele: Symptoms, Diagnosis, and Treatment Options

When it comes to anal health, there are several conditions that cause discomfort and concern. Among the most common of these conditions are haemorrhoids, rectal prolapse, and rectocele. 

These terms may sound complex, but understanding them is essential for anyone who has ever experienced discomfort or distress in the anal region.

This article differentiates haemorrhoids vs rectal prolapse and rectocele. It explores the nuances, symptoms, diagnosis, and effective treatment options. 

What Are Haemorrhoids?

Haemorrhoids, also known as piles, are a common anal condition that many people experience at some point in their lives. 

According to a study, about 75% of people will get haemorrhoids at some point in their lives. They can be painful and itchy and often lead to discomfort during bowel movements.

Types Of Haemorrhoids

Haemorrhoids manifest as swollen blood vessels found in the vicinity of the rectum or around the anus. They can be categorised into two primary types:

  • Internal Haemorrhoids: These haemorrhoids develop within the rectum, making them typically painless. However, they can lead to noticeable bleeding during bowel movements.
  • External Haemorrhoids: In contrast, external haemorrhoids form outside the anus. They are often associated with pain, discomfort, and itching. Individuals with external haemorrhoids may experience visible protrusions from the anal opening, a condition referred to as prolapsed haemorrhoids.

Common Symptoms Of Haemorrhoids

  • Internal haemorrhoids are usually painless and can cause bleeding during bowel movements.
  • External haemorrhoids, on the other hand, can be painful and may cause itching or discomfort.
  • Haemorrhoids can vary in size, and some may protrude from the anus (prolapsed haemorrhoids).

Causes And Risk Factors Of Haemorrhoids

  • Increased Pressure: One of the primary causes of haemorrhoids is increased pressure on the blood vessels in the rectal area. This heightened pressure is often the result of straining during bowel movements because of chronic constipation or diarrhoea.
  • Obesity: People who are overweight tend to get haemorrhoids as the excess body weight can exert additional pressure on the anal and rectal veins.
  • Pregnancy: Pregnant women may develop haemorrhoids due to increased pressure on the pelvic area by the growing uterus. Hormonal changes during pregnancy may also weaken blood vessel walls.
  • Low-Fibre Diet: This type of diet can lead to constipation, which, in turn, increases the likelihood of straining during bowel movements and the development of haemorrhoids.
  • Sedentary Lifestyle: Lack of physical activity and prolonged periods of sitting can cause poor blood circulation in the rectal area, increasing the risk of haemorrhoids.
  • Age and Gender: The condition is known to increase in prevalence with age, reaching its highest levels in older age groups. It’s more prevalent in parous women (women who have given birth) compared to men and nulliparous women, likely due to changes in the pelvic floor during pregnancy and labour. 

What Is Rectal Prolapse?

Rectal prolapse is another condition that affects the rectum, and it can be distressing for those who experience it. It occurs when the rectum protrudes through the anus. It can be partial or complete, depending on the extent of the protrusion.

Rectal prolapse is often part of a broader range of pelvic floor disorders, which can include symptoms like anal fissures or haemorrhoids. These conditions can coexist and often require a detailed assessment for appropriate management.

Common Symptoms Of Rectal Prolapse

  • One of the hallmark symptoms of rectal prolapse is the presence of a visible bulge or mass that protrudes from the anus. This bulge can be concerning and may cause embarrassment for those experiencing it.
  • Discomfort and unease are often associated with rectal prolapse. The sensation of having a portion of the rectum protruding can be distressing and painful.
  • Bowel movements can become challenging for individuals with rectal prolapse, leading to difficulty during the process.
  • Rectal prolapse can result in faecal incontinence, which is the inability to control bowel movements. 

Causes And Risk Factors Of Rectal Prolapse

  • Weakness in the pelvic floor muscles is a primary underlying cause of rectal prolapse. These muscles play a crucial role in supporting the rectum and maintaining its proper position.
  • Chronic constipation is a common contributing factor to rectal prolapse. Repeated straining during bowel movements, often associated with chronic constipation, can weaken the pelvic floor muscles and increase the risk of prolapse.
  • Certain medical conditions, such as Ehlers-Danlos syndrome and cystic fibrosis, can also predispose individuals to rectal prolapse. These conditions affect connective tissues and can lead to structural weaknesses in the pelvic region.
  • Moreover, rectal prolapse can occur due to ageing, childbirth, previous injury or surgery to the pelvis, chronic coughing or sneezing, spinal cord damage, and nerve damage.

Some people are confused between haemorrhoids and rectal prolapse because they share some similar symptoms, including rectal bleeding, discomfort, and a feeling of something protruding from the anus. 

In cases of partial rectal prolapse, the protruding rectal tissue can resemble a lump or bulge that may be mistaken for external haemorrhoids. 

What Is Rectocele?

Rectocele is another pelvic floor disorder affecting the rectum and surrounding area. It’s a condition where the wall of the rectum stretches and bulges into the vagina. It primarily affects women and can vary in severity, with some cases being minor and others more pronounced.

Common Symptoms

  • Rectocele can lead to various troublesome symptoms, including difficulties with bowel movements. People with this problem often have trouble going to the bathroom properly. They might feel like they can’t empty their bowels completely or need to push really hard.
  • Unlike haemorrhoids and rectal prolapse, rectocele does not typically manifest as visible bulges protruding from the anus. Instead, it is characterised by an internal protrusion into the vaginal wall.
  • Pain associated with rectocele tends to be less severe compared to the discomfort and pain commonly seen in haemorrhoids and rectal prolapse.
  • The prognosis for rectocele often hinges on the condition’s severity and the effectiveness of the chosen treatment approach.

Causes And Risk Factors

  • Childbirth, particularly vaginal delivery, is a significant risk factor for the development of rectocele. The strain and pressure exerted on the pelvic floor muscles during childbirth can lead to the weakening of these muscles, creating conditions conducive to the development of rectocele.
  • Other risk factors include the natural ageing process, as pelvic floor muscles tend to weaken with age. Additionally, obesity and chronic constipation can contribute to the risk of rectocele by placing increased pressure on the pelvic region.

Key Differences Between Haemorrhoids, Rectal Prolapse, And Rectocele

One challenge in distinguishing these conditions is that they share some common symptoms, including rectal bleeding and discomfort during bowel movements. The overlapping symptoms can sometimes lead to confusion.

While these conditions share some symptoms, these key differences can help healthcare professionals accurately diagnose and provide appropriate treatment.

Location And Nature Of The Condition

  • Haemorrhoids: Haemorrhoids involve swollen blood vessels in the rectal or anal area. The enlargement of vascular structures characterises them and can be either internal (inside the rectum) or external (outside the anus). They do not involve the actual protrusion of rectal or vaginal tissue.
  • Rectal Prolapse: Rectal prolapse entails the actual protrusion of the rectal tissue through the anus. It is a structural issue where a segment of the rectum becomes displaced, leading to its visible protrusion. This condition is distinct from haemorrhoids involving blood vessels rather than the rectal wall itself.
  • Rectocele: Unlike haemorrhoids and rectal prolapse, rectocele primarily affects women. It involves the protrusion of the front wall of the rectum into the vaginal wall. Rectocele occurs internally and does not typically result in visible bulges from the anus.

Visible Protrusion

  • Haemorrhoids: External haemorrhoids may be visible outside the anus, but internal haemorrhoids are not typically visible. They may cause discomfort, pain, and bleeding but do not involve tissue protrusion.
  • Rectal Prolapse: Rectal prolapse involves the visible protrusion of rectal tissue from the anus. This protrusion can vary in extent, from partial to complete, and is a distinguishing feature of this condition.
  • Rectocele: Rectocele does not typically cause visible bulges from the anus. The protrusion occurs internally, into the vaginal wall, making it different from haemorrhoids and rectal prolapse in terms of appearance.

Diagnostic Procedures For Haemorrhoids, Rectal Prolapse, And Rectocele

Diagnostic procedures for haemorrhoids, rectal prolapse, and rectocele may include a combination of medical history assessments, physical examinations, and specialised tests to accurately diagnose these conditions. 

Here’s an overview of the diagnostic procedures commonly used for each of these anal conditions

Diagnosing Haemorrhoids

  • Medical History: The doctor needs a detailed medical history and information about your symptoms, their duration, and any relevant risk factors or previous occurrences to diagnose your condition.
  • Physical Examination: A physical examination of the anal area will be performed. This may involve visually inspecting the anus for external haemorrhoids and using a lubricated, gloved finger to assess for internal haemorrhoids.
  • Proctoscopy or Anoscopy: In some cases, a proctoscopy or anoscopy may be performed. These procedures involve inserting a thin, lighted tube (proctoscope or anoscope) into the rectum to examine the rectal and anal area more closely.
  • Colonoscopy: A colonoscopy may be recommended if bleeding is severe or other colon-related issues are suspected. This procedure allows for a comprehensive examination of the entire colon and rectum.

Diagnosing Rectal Prolapse

  • Medical History: Similar to haemorrhoids, a detailed medical history will be taken to understand your symptoms, their onset, and any relevant factors.
  • Physical Examination:  A physical examination is required to assess the appearance of the rectal prolapse. They may ask you to strain or bear down during the examination to observe the extent of the prolapse.
  • Defecography: In some cases, a defecography test may be conducted. This radiologic procedure involves swallowing a contrast medium, followed by X-ray imaging while you have a bowel movement. It helps in evaluating the dynamics of the rectum and rectal prolapse during defecation.

Diagnosing Rectocele

  • Medical History: As with the other conditions, the medical history will be crucial in assessing symptoms and risk factors related to rectocele.
  • Rectovaginal Examination: A pelvic examination will be performed to evaluate the presence and extent of the rectocele. This may include a rectovaginal examination in women to assess the vaginal wall and rectum.
  • Defecography: Similar to rectal prolapse, a defecography test may be used to evaluate the extent and dynamics of the rectocele during bowel movements.

Treatments For Haemorrhoids, Rectal Prolapse, And Rectocele

Once properly diagnosed, the treatment options for haemorrhoids, rectal prolapse, and rectocele can vary depending on the severity and specific condition. Here are the treatment options available:

Haemorrhoids Treatment Options

  • Lifestyle Changes: For mild cases, eating high-fibre food, drinking plenty of water, and avoiding prolonged sitting can alleviate symptoms.
  • Topical Creams and Ointments: Over-the-counter or prescription creams can help reduce pain and inflammation.
  • Minimally Invasive Procedures: Procedures like rubber band ligation or sclerotherapy are effective for treating internal haemorrhoids.
  • Surgical Interventions: In severe cases or for external haemorrhoids where the affected area around the anus appears swollen and inflamed, surgical removal (hemorrhoidectomy) may be necessary.

Rectal Prolapse Treatment Options

  • Conservative Approaches: Mild cases may be managed with lifestyle changes, including dietary modifications and pelvic floor exercises.
  • Pelvic Floor Exercises: Pelvic floor exercises for rectal prolapse focus on strengthening the muscles in the pelvic area. These exercises involve repeatedly contracting and relaxing the muscles that form part of the pelvic floor. 
  • Laparoscopic Approaches: Studies have reported good results with acceptable morbidity for perineal and laparoscopic/abdominal approaches to treating rectal prolapse. This includes methods like laparoscopic suture rectopexy and ventral rectopexy. These techniques have shown promise in providing effective treatment with reduced recovery times and complications.
  • Surgical Procedures: Severe or complete rectal prolapse may require surgical repair. Procedures can include abdominal surgery (rectopexy) or resection of the prolapsed segment.

Rectocele Treatment Options

  • Conservative Management: Mild rectocele can often be managed through dietary changes, such as increasing fibre intake to prevent constipation.
  • Pelvic Floor Exercises and Physical Therapy: Kegel exercises and other techniques can help strengthen pelvic floor muscles.
  • Surgical Interventions: In severe cases that do not respond to conservative measures, surgical repair may be considered. Surgical options include anterior repair or posterior colporrhaphy.

Conclusion About Haemorrhoids Vs Rectal Prolapse Vs Rectocele

Haemorrhoids involve swollen blood vessels in the rectal or anal area and can be either internal or external. Rectal prolapse entails the protrusion of rectal tissue through the anus, whereas rectocele involves the front wall of the rectum protruding into the vaginal wall, primarily affecting women. 

While all three conditions can cause discomfort and difficulties with bowel movements, recognising these differences is essential for accurate diagnosis and tailored treatment.

Seeking prompt medical advice and consulting with healthcare professionals, such as colorectal surgeons and specialists like Dr QM Leong, can provide the specialised knowledge and expertise needed to address these conditions effectively. 

With the right guidance, individuals can navigate these anal health concerns, improving their quality of life and overall well-being.

Frequently Asked Questions About Haemorrhoids Vs Rectal Prolapse Vs Rectocele

Are These Conditions Preventable?

While it may not be possible to prevent them entirely, lifestyle changes such as a high-fibre diet, regular exercise, and maintaining proper bowel habits can help reduce the risk of these conditions.

Can Haemorrhoids, Rectal Prolapse, Or Rectocele Go Away On Their Own?

Some mild cases may improve with conservative measures, but in many cases, these conditions may require medical intervention or surgery for effective treatment.

What Are The Long-Term Implications Of These Conditions If Left Untreated?

If left untreated, these conditions can lead to persistent discomfort, pain, and complications such as anaemia (from chronic bleeding in haemorrhoids) or faecal incontinence (in severe rectal prolapse cases). Seeking timely treatment is essential.

Can These Conditions Recur After Treatment?

Yes, recurrence is possible, especially if underlying causes or risk factors are not addressed. Follow-up care and ongoing management may be necessary to prevent recurrence.