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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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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.

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Testimonial by Ann V.

I wish i could give this place 10 stars!! 
I have been suffering from vaginismus for 5 years and never found the cure to it. I had seen an ob/gyn and he diagnosed me with vaginismus and told me i needed a surgery to cure my condition, which i refused to do. He also referred me to a PT that he works with, i had given them multiple calls and they never responded back to me, so i started searching yelp for another PT. I am SO HAPPY I found Heather's office! I was working with Laureen, and with her guidance and techniques i was able to be cured from vaginismus in only 2 1/2 short months!!! I couldn't believe how quickly their program worked for me! I am forever grateful and thankful from Heather, and Laureen! They are the absolute best at what they do!

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Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

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Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

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