Prolapsed internal hemroids

Mucosal Prolapse and Full-Thickness Rectal Prolapse (Procidentia) 

Patients may present with protrusion of tissue through the anus but, on examination, little evidence of hemroidsal disease can be found. In these circumstances, the mucosa of the rectum or anal canal or the entire thickness of the rectal wall may have prolapsed into the anal outlet. Mucosal prolapse is complete eversion of the anal mucosa. On the other hand, rectal prolapse is a full-thickness evagination of the rectal wall outside the anal opening. In rectal prolapse, concentric folds are found on the surface of the prolapsed tissue, whereas radial folds are noted on the surface in mucosal prolapse. With full-thickness rectal prolapse, the anus is in its normal anatomic position, whereas in mucosal prolapse the anoderm is also everted and visible externally (Figure 10). Accordingly, in full-thickness rectal prolapse, there is a sulcus between the anus and the everted bowl. This is absent in mucosal prolapse. 

In either situation, the treatment is usually surgical. Full-thickness rectal prolapse usually requires a resection of the bowel. For mucosal prolapse, the excision of the redundant mucosa is all that is required.