Is rectal prolapse the same as hemorrhoids?

Written by Deng Heng
Colorectal Surgery
Updated on January 27, 2025
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Rectal prolapse and hemorrhoids are two different diseases. Rectal prolapse refers to the condition where the rectal mucosa, or sometimes the entire rectal wall, prolapses downwards during defecation, prolonged standing, or fatigue, especially in severe cases. Hemorrhoids, on the other hand, involve the prolapse of vascular cushions and anal padding, sometimes accompanied by symptoms like rectal bleeding. The causes, mechanisms, pathology, symptoms, and treatment methods of these two conditions are distinct, making rectal prolapse and hemorrhoids two separate diseases.

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Written by Chen Tian Jing
Colorectal Surgery
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How is rectal prolapse graded?

Rectal prolapse is generally graded into three degrees: first degree rectal prolapse, second degree rectal prolapse, and third degree rectal prolapse. First degree rectal prolapse is a relatively minor condition where the rectal mucosa protrudes but can retract back on its own. Second degree rectal prolapse is a moderate condition where the protruding mucosa extends approximately 5-10 centimeters, generally forming a conical shape, and requires the patient to manually reposition it. Third degree rectal prolapse indicates a severe condition, with the prolapsed mucosa typically extending beyond 10 centimeters. It may protrude with each incident and could also occur when the patient strains the abdomen or squats. The treatment of second and third degree rectal prolapse generally requires surgical intervention.

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Colorectal Surgery
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Causes of rectal prolapse

The causes of rectal prolapse primarily include older age or physical weakness leading to relaxation and sagging of the pelvic and rectal mucosa. Prolonged constipation can also lead to excessive straining during bowel movements, causing stress-induced sagging of the intestinal mucosa. Additionally, women who have gone through childbirth may experience rectal prolapse due to excessive straining of the pelvic floor muscles during delivery or increased abdominal pressure during pregnancy, which compresses the rectal mucosa. The treatment for rectal prolapse mainly consists of conservative medication or surgical removal. For mild cases of rectal prolapse, including those in children, traditional Chinese medicine enemas can be used. However, for moderate to severe cases, or cases where prolapse recurs frequently and significantly forms a complete prolapse, surgical removal is recommended.

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Colorectal Surgery
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Can rectal prolapse cause bleeding during bowel movements?

Patients with rectal prolapse may experience bleeding during bowel movements. The primary symptom of rectal prolapse is a protrusion of a swelling through the anus. Initially, the swelling is small and only protrudes during bowel movements, retracting on its own afterwards. As the condition progresses, due to a lack of contraction strength in the levator ani and anal sphincter muscles, the prolapse occurs more frequently and increases in size, requiring manual repositioning back into the anus after defecation. If not repositioned timely, the prolapsed intestinal tract can become edematous, constricted, or even necrotic, which may result in bloody stools.

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Rectal prolapse treatment

Rectal prolapse is primarily categorized into mild rectal prolapse as well as moderate and severe rectal prolapse. Mild rectal prolapse generally occurs in the early stages of the illness or in children and can be treated conservatively. Conservative treatment mainly involves Chinese herbal retention enemas. On the other hand, moderate and severe rectal prolapse can result in the protrusion of the local mucosa outside the anus, presenting as cylindrical or cone-shaped prolapses. Treating moderate to severe hemorrhoidal prolapse requires surgical intervention. The main surgical methods include hemorrhoidal mucosectomy with stapling and local submucosal sclerosant injections. It is also important to caution postoperative patients against squatting for long periods or straining during constipation, as these actions can exacerbate symptoms of submucosal prolapse.

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What is the pathogenic mechanism of rectal prolapse?

The pathogenic mechanism of rectal prolapse primarily refers to the relaxation and sagging of the rectal mucosa down to the anal area, forming an internal rectal mucosa prolapse. Excessive relaxation of the rectal mucosa can protrude externally through the anus in a cylindrical or conical shape, commonly known as external rectal mucosa prolapse or rectal prolapse. The causes are mainly due to congenital deficiency of kidney energy in patients or excessive relaxation of the rectal mucosa due to multiple childbirths. Some patients with long-term constipation may also experience rectal mucosal relaxation due to excessive straining during bowel movements. Additionally, elderly and frail patients may experience sagging of the rectal mucosa as they age.