People can tell the difference easily when the hemorrhoids are external, so I guess you are trying to differ internal hemorrhoids and rectal prolapse. Doctors can tell when seeing it of course. At home, there're two things to note. First, internal hemorrhoids cause bleeding, bright fresh red blood, blood comes out either before or after bowel movement. The bleeding of rectal prolapse occurs in the middle and late stages. Second, the pain of internal hemorrhoids isn't obvious, because the internal hemorrhoid is located in the mucosa and the nerve distribution is less. While in the middle and late stages of prolapse, people are prone to anal pain, affecting walking, sitting and defecation.