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Definition

What is rectal prolapse?

The term rectal prolapse often is used synonymously with complete rectal prolapse (external rectal prolapse), where the rectal walls have prolapsed to a degree where they protrude out the anus and are visible outside the body. Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may be mucous discharge (mucus coming from the anus), rectal bleeding, degrees of fecal incontinence and obstructed defecation symptoms.

How common is rectal prolapse?

Rectal prolapse is generally more common in elderly women, although it may occur at any age and in both sexes. It is very rarely life-threatening, but the symptoms can be debilitating if left untreated. Most external prolapse cases can be treated successfully, often with a surgical procedure. Internal prolapses are traditionally harder to treat and surgery may not be suitable for many patients.

However, it can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of rectal prolapse?

Signs and symptoms of rectal prolapse include:

  • History of a protruding mass.
  • Degrees of fecal incontinence, which may simply present as a mucous discharge.
  • Constipation also described as tenesmus (a sensation of incomplete evacuation of stool) and obstructed defecation.
  • A feeling of bearing down.
  • Rectal bleeding.
  • Diarrhea and erratic bowel habits.
  • Initially, the mass may protrude through the anal canal only during defecation and straining, and spontaneously return afterwards. Later, the mass may have to be pushed back in following defecation. This may progress to a chronically prolapsed and severe condition, defined as spontaneous prolapse that is difficult to keep inside, and occurs with walking, prolonged standing, coughing or sneezing (Valsalva maneuvers). A chronically prolapsed rectal tissue may undergo pathological changes such as thickening, ulceration and bleeding.

If the prolapse becomes trapped externally outside the anal sphincters, it may become strangulated and there is a risk of perforation. This may require an urgent surgical operation if the prolapse cannot be manually reduced. Applying granulated sugar on the exposed rectal tissue can reduce the edema (swelling) and facilitate this.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consulting with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes rectal prolapse?

The precise cause is unknown and has been much debated. There is some underlying abnormality of the pelvic floor that affects multiple pelvic organs. Proximal bilateral pudendal neuropathy has been demonstrated in patients with rectal prolapse who have fecal incontinence. This finding was shown to be absent in healthy subjects and may be the cause of denervation-related atrophy of the external anal sphincter. Some authors suggest that pudendal nerve damage is the cause for pelvic floor and anal sphincter weakening and may be the underlying cause of a spectrum of pelvic floor disorders.

This finding was shown to be absent in healthy subjects and may be the cause of denervation-related atrophy of the external anal sphincter. Some authors suggest that pudendal nerve damage is the cause for pelvic floor and anal sphincter weakening and may be the underlying cause of a spectrum of pelvic floor disorders.

Risk factors

What increases my risk for rectal prolapse?

Many things increase the chance of developing rectal prolapse. Risk factors for children include:

  • Cystic fibrosis. A child who has rectal prolapse with no obvious cause may need to be tested for cystic fibrosis.
  • Having had surgery on the anus as an infant.
  • Malnutrition.
  • Deformities or physical development problems.
  • Straining during bowel movements.
  • Infections.

Risk factors for adults include:

  • Straining during bowel movements because of constipation.
  • Tissue damage caused by surgery or childbirth.
  • Weakness of pelvic floor muscles that occurs naturally with age.

Diagnosis & Treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

 

How is rectal prolapse diagnosed?

By asking you questions about your symptoms and past medical problems and surgeries, your doctor will diagnose rectal prolapse. He or she will also do a physical exam, which includes checking the rectum for loose tissue and to find out how strongly the anal sphincter contracts.

You may need tests to rule out other conditions. For example, you may need a sigmoidoscopy, a colonoscopy, or a barium enema to look for tumors, sores (ulcers), or abnormally narrow areas in the large intestine. Or a child may need a sweat test to check for cystic fibrosis if prolapse has occurred more than once or the cause is not clear.

How is rectal prolapse treated?

In its early stages, rectal prolapse may be treated with stool softeners, suppositories and other medications. But most people eventually need surgery to repair rectal prolapse.

The type of surgery you have depends on the extent of the rectal prolapse and any other health concerns. Surgeons will select the surgery that is right for you. They may recommend one of these procedures.

  • Perineal proctectomy: Options include the Altemeier procedure and the Delorme procedure. In both procedures, the surgeon removes the prolapsed rectum via an incision in the protruding rectum. Perineal proctectomy can sometimes be performed using spinal anesthesia, which reduces the risk of complications and speeds your recovery.
  • Sigmoid resection and rectopexy: The surgeon makes an incision in the abdomen and removes the sigmoid colon, the part of the large intestine closest to the rectum and anus. The rectopexy procedure anchors the rectum to a bony structure attached to the lower spine and pelvis (sacrum). In most cases it is possible to perform this operation using minimally invasive surgery, which results in smaller incisions and a shorter hospital stay than do conventional surgery.
  • Rectopexy: Sometimes surgeons will perform rectopexy alone, without removing any of the colons. In this case they may use robotic surgery.

In children, rectal prolapse can usually be managed with stool softeners or other medication. If surgery is needed, surgeons have special experience in minimally invasive techniques.

Children with rectal prolapse should be screened for cystic fibrosis, since rectal prolapse can be a sign of that disease.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage rectal prolapse?

To treat the underlying conditions that cause or perpetuate rectal prolapse, we need to address a number of possible factors:

  • Painful rectal area – Following prolapse, you may experience pain in the muscles surrounding the rectum; the levator ani muscles. If you feel your muscles from your sit bones (the “sitting bones” you can feel at the bottom of your bum when you sit on a bicycle or hard seat), working up both sides of your buttocks and across just under your sacrum (the flat, slightly rounded pad of bone at the base of your spine) – you are feeling the levator ani muscles. There are a number of techniques you can use to reduce or eliminate pain in this area.
  • Straining to defecate or improper defecation position – The western practice of sitting on the toilet prevents the rectum from straightening out and opening – making us much more prone to constipation, hemorrhoids and fissures. Constipation can play a major role in rectal prolapse and ongoing aggravation.
  • Weakened, stretched or traumatized pelvic muscles – If you apply gentle counter-pressure to the muscles closest to the area where your rectum protrudes when you’re having a bowel movement, you may be able to hold the rectum inside and avoid it coming out with the stool.
  • Bodywork therapy – The anorectal canal is girdled by muscles and ligaments, which the pudendal nerve runs through. Following surgery, childbirth, or any kind of trauma or continual strain, you can develop muscle, tendon or ligament strains in corresponding tissues or organs. This strain and weakening of the muscles and ligaments can lead to rectal prolapse. The other thing that will greatly help you to heal the underlying cause of your prolapse is bodywork therapy from a specifically trained practitioner.

If you have any questions, please consult with your doctor to better understand the best solution for you.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: March 7, 2017 | Last Modified: March 7, 2017

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