Rectal prolapse or haemorrhoids: what is the difference and when is surgery needed

The rectum is the last part of the large bowel, which continues into the anal canal. In rectal prolapse the wall of the rectum drops down and comes out through the anus. At first this usually happens only during a bowel movement or straining, and the bowel then goes back by itself. Over time the prolapse may come out more often, need to be pushed back by hand or stay out all the time.

Rectal prolapse is more common in older people, with long-term constipation and straining, and with weakness of the pelvic floor muscles. Mucus, dampness or difficulty holding stool can accompany a prolapse.

Haemorrhoids are normal blood vessels and cushions of tissue in the anal canal that help close the anus. They are called a problem when these cushions become enlarged. They may then bleed, usually bright red blood with a bowel movement, itch or burn, and enlarged internal haemorrhoids can come out through the anus.

Haemorrhoids are graded by whether they come out and whether they go back by themselves. Treatment starts with advice on diet and bowel habits, and the doctor chooses the treatment method, including surgery, based on the grade and the examination.

Rough differences:

• In rectal prolapse the whole wall of the bowel comes out, so circular folds around the opening are usually seen. Prolapsing haemorrhoids usually look like separate lumps.
• Rectal prolapse is usually larger and more visible when straining.
• Bright red bleeding is more common with haemorrhoids, while mucus and dampness are more common with rectal prolapse.

These differences help, but they are not reliable, and sometimes both conditions are present at the same time. The same signs, such as bleeding, can also have other causes. That is why the doctor always determines the difference at an examination, and you should not try to judge it yourself.

The examination starts with a conversation about symptoms, bowel habits and previous illnesses. The doctor then examines the skin around the anus and the last part of the bowel with a gloved finger (digital rectal examination). Sometimes the doctor asks you to strain as if passing stool, to see whether something comes out and what it is.

Based on the findings, the doctor suggests treatment or further tests, such as a colonoscopy, an examination of the whole large bowel. The examination is short, and the doctor explains what they are doing. Bring earlier results and a list of medicines you take.

In adults rectal prolapse usually does not go away on its own and cannot be cured with medicines alone. Advice on soft stools and avoiding straining can ease symptoms, but surgery is the most common treatment.

The operation can be done through the abdomen or through the anus. In surgery through the abdomen, the rectum is lifted and fixed in its normal position, which is called rectopexy. Laparoscopic rectopexy is done through several small cuts with a camera. The general surgery price list of Maja Hospital includes rectal prolapse surgery and laparoscopic rectopexy for rectal prolapse.

The surgeon decides which approach is suitable after the examination, based on the findings, age and general health. After surgery the surgeon gives instructions on diet, bowel movements and activity.

Urgent examination is needed if bowel that has come out cannot be pushed back, turns dark, becomes very painful or swollen, or if bleeding is heavy. In that case call the emergency service on 194 or go to the nearest emergency department.

Any new bleeding from the anus, a lasting change in bowel habits or unexplained weight loss should be shown to a doctor, even if it seems to be haemorrhoids.