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Rectal Prolapse and Hemorrhoids

Do You Know the Difference Between Rectal Prolapse and Hemorrhoids?

We continue Pelvic Organ Prolapse Awareness Month by talking about Rectal prolapse and hemorrhoids, two conditions that are commonly mistaken for one another.

Rectal prolapse and hemorrhoids can both cause irritation, discomfort, and pain in the anal region. However the causes and treatment can be different for both conditions.

Hemorrhoids

Hemorrhoids are veins in the lower rectum that become swollen or stretched. They are similar to varicose veins in the lower legs. There are two types of hemorrhoids: internal and external.

Internal hemorrhoids are swollen veins inside the rectum. Sometimes these swollen veins begin to descend and come out through the anal sphincter.

External hemorrhoids: are swollen veins that can be seen and often felt under the skin outside around the anal sphincter. Usually they look like a small bulge and are the same color as the skin.

Hemorrhoid Symptoms

The most common signs of hemorrhoids are:

  • Bright red blood on toilet paper
  • Drops of blood in the stool
  • Pain at the anus
  • Burning, pressure, or intense itchiness at the anus

About 75% of adults in America will have hemorrhoids at some point in their lives.

Causes of hemorrhoids

Rectal Prolapse

Rectal prolapse occurs when the points of attachment of the rectum (the last part of the colon, before the anal sphincter) become overstretched or detach from inside the body, and begins to descend out of the anus.

Rectal Prolapse Symptoms

When comparing rectal prolapse and hemorrhoids, rectal prolapse can cause symptoms similar to hemorrhoids, including:

  • Bright red blood on toilet paper
  • Drops of blood in the stool
  • Pain at the anus
  • Burning, pressure, or intense itchiness at the anus

Other symptoms that are specific to rectal prolapse and not usually present in hemorrhoid cases include:

  • Incontinence or leakage of stool.
  • A feeling of fullness in the bowel
  • Tissue coming out of the anus looks like it is “telescoping” and has the appearance of concentric circles.

Causes of Rectal Prolapse

  • Chronic constipation or diarrhea
  • History of straining during bowel movements
  • Pelvic floor muscle weakness
  • Deterioration of the muscles and ligaments of the rectum due to age.
  • Weakening of the anal sphincter: This is the specific muscle that controls the release of stool from the rectum.
  • Prior injury to the anal or pelvic areas including pregnancy, labor, and delivery.
  • Nerve damage as a result of pregnancy, vaginal childbirth, anal sphincter paralysis, spinal injury, back injury/back surgery, and/or other surgeries of the pelvic area.
  • Other diseases, conditions, and infections: Rectal prolapse can be a consequence of diabetes, cystic fibrosis, chronic obstructive pulmonary disease, hysterectomy, and infections in the intestines caused by parasites – such as pinworms and whipworms – and diseases resulting from poor nutrition or from difficulty digesting foods.

Treatment for rectal prolapse and hemorrhoids with pelvic floor physical therapy

Surgery is the best treatment in severe cases of rectal prolapse. In less severe cases of rectal prolapse and hemorrhoids, a trained and licensed pelvic floor physical therapist, like us at Femina Physical Therapy, can help treat the toileting habits and pelvic floor dysfunction that is associated with both conditions.

A licensed pelvic floor therapist can conduct a thorough evaluation of the pelvic floor and help you come up with strategies to have a bowel movement without straining.

Examination may include an internal exam via the vagina or rectum, observing the movement and coordination of the pelvic floor muscles, as well as palpation of the structures of the belly and pelvic area.

The ultimate goal of our treatment plans at Femina Physical Therapy is to help you fully relax the pelvic floor, and to be able to have a complete bowel movement without the strain or pain brought on by rectal prolapse and hemorrhoids. This might include manual therapy to treat tight and guarding pelvic floor muscles that may be preventing healthy bowel movements.

Other treatments will help with neuromuscular retraining, helping your brain and muscles coordinate correctly so that you are actually relaxing your muscles when you think you are relaxing them. Your therapist will also work with you to create healthy bowel habits, problem solve positioning on the toilet, the time you are spending on the toilet, and other habits that can help create regularity.

There are plenty of options for treating both rectal prolapse and hemorrhoids. For those with rectal prolapse, a pelvic floor physical therapist will also be able to help strengthen the pelvic floor muscles that are too weak to support your organs when the time is right.

 

References:

American College of Gastroenterology. Rectal Problems in Women. https://patients.gi.org/topics/rectal-problems-in-women/

American Society of Colon & Rectal Surgeons. Mahmoud NN. Rectal Prolapse. https://www.fascrs.org/patients/disease-condition/rectal-prolapse-expanded-version

Cleveland Clinic. Rectal Prolapse. https://my.clevelandclinic.org/health/diseases/14615-rectal-prolapse

Mayo Clinic. Hemorrhoids. https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268

 

**This information is for educational purposes only and is not intended to replace the advice of your doctor.

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What Our Patients Have to Say

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Testimonial by Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

-- Carolina J., 12/28/16 via Yelp!

Testimonial by R.D., age 38

"I had a severe tear during childbirth that was not stitched together correctly and therefore healed poorly. Even after having a surgery a year later to remove the scar tissue, I was still having pain, and no one could explain why -- there was no overt 'reason' to explain the pain. I had tried other 'specialists' and even saw another physical therapist who had me do hip / leg stretches -- what a joke! I was about to give up and just 'live with it' until thankfully I kept searching online and found Heather.

Read more: Testimonial by R.D., age 38

Testimonial by J.H.

My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

Read more: Testimonial by J.H.

Testimonial by Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

-- Carolina J., 12/28/16 via Yelp!

Testimonial by S.B.

As someone who suffered the debilitating physical and emotional effects of vaginismus (as well as a complicated history of back injuries) for more than 15 years, I thought a "normal" life was just a fantasy. Then I found Heather.

Read more: Testimonial by S.B.

Testimonial by Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

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