Benign lesions prolapsing through the anus: a differential diagnostic algorithm and evidence-based surgical management—a narrative review

Masses prolapsing through the anus represent a frequent diagnostic challenge in coloproctological practice. Misidentification may delay the management of malignant disease or surgical emergencies. This narrative review integrates current evidence on seven benign entities that may prolapse through the anus—complete rectal prolapse, mucosal rectal prolapse, internal hemorrhoids, thrombosed hemorrhoids, anal condylomas, hypertrophied anal papilla, and anal canal polyps—and proposes a clinical decision algorithm based on findings from physical examination. Particular emphasis is placed on the identification of red flags that require exclusion of malignancy or surgical emergency. The evidence supporting the different therapeutic options is critically analyzed. The proposed algorithm prioritizes objective clinical characteristics—fold pattern, texture, mobility, and anatomical location—to guide differential diagnosis and the sequence of complementary studies, optimizing surgical decision-making.