Rectal prolapse is a medical condition in which the rectum protrudes through the anus.
The rectum is the final section of the large intestine. The anus is the end of your large intestine, where waste leaves your body when you have a bowel movement.
With rectal prolapse, part of the rectum slips out through the anus. This can cause a visible bulge, straining, leakage, and a feeling of pressure.
Rectal prolapse is often caused by chronic straining from constipation, long-term diarrhea, or childbirth.
Learn more about rectal prolapse, including its definition, causes, symptoms, diagnosis, treatment, and potential risks and complications.
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What is rectal prolapse?
Rectal prolapse occurs when the rectum loses its normal attachments within the body, allowing it to slip or prolapse out through the anus. This condition can range from partial prolapse, where only the rectal lining protrudes, to complete prolapse, where the entire rectal wall is displaced. Rectal prolapse often affects older adults, particularly women, but it can occur at any age.
Causes of rectal prolapse
Weakened pelvic floor
- Childbirth: Vaginal deliveries can weaken the pelvic floor muscles and connective tissues.
- Aging: Decreased muscle tone and strength associated with aging.
Chronic straining
- Chronic constipation: Frequent straining during bowel movements can weaken the rectal and pelvic floor muscles.
- Chronic diarrhea: Persistent loose stools can also contribute to straining and weakening of the tissues.
Other contributing factors
- Previous surgery: Pelvic or rectal surgery can weaken the support structures of the rectum.
- Neurological conditions: Conditions that affect nerve function, such as spinal cord injury, multiple sclerosis, or Parkinson’s disease.
- Genetic predisposition: A family history of rectal prolapse may increase the risk.
- Chronic coughing: Persistent coughing can place additional pressure on the pelvic floor.
Children
- Congenital factors: Some children are born with weak pelvic floor muscles or connective tissues.
- Cystic fibrosis: Children with cystic fibrosis often have chronic coughing and constipation, increasing the risk.
Symptoms of rectal prolapse
Visible prolapse
- Protrusion: A noticeable bulge or protrusion from the anus, which may occur during bowel movements or physical activity and can retract or require manual repositioning.
Discomfort and pain
- Pain: Pain or discomfort in the rectal area, especially during bowel movements.
- Feeling of incomplete evacuation: The sensation that the rectum is not fully emptied during bowel movements.
Bowel issues
- Incontinence: Inability to control bowel movements, ranging from mild to severe.
- Constipation: Difficulty passing stools due to obstruction caused by the prolapsed rectum.
Other symptoms
- Bleeding and mucus discharge: Presence of blood or mucus in the stool.
- Irritation and itching: Itching or irritation around the anus due to prolapse and mucus discharge.
More about anal itching (pruritus ani)>>
Diagnosis of rectal prolapse
Medical history and physical examination
- Symptom assessment: Detailed inquiry about the presence, duration, and severity of symptoms like prolapse, pain, incontinence, and bowel issues.
- Physical examination: Visual inspection and digital rectal exam to assess the degree of prolapse and other rectal abnormalities.
Additional diagnostic tests
- Defecography: A special X-ray or MRI that visualizes the rectum and anal canal during bowel movements to assess the extent of prolapse.
- Colonoscopy: To rule out other underlying conditions, such as tumors or inflammatory bowel disease, that might contribute to symptoms.
- Anal manometry: To measure the strength of the anal sphincter muscles and evaluate nerve function.
- Electromyography (EMG): To assess the electrical activity of pelvic floor muscles and identify any neurological issues.
Treatment of rectal prolapse
Conservative treatments
- Dietary changes: Increasing fiber intake through fruits, vegetables, whole grains, and fiber supplements to soften stools and reduce straining.
- Hydration: Drinking plenty of fluids to help prevent constipation.
- Bowel habit adjustments: Avoiding prolonged sitting or straining during bowel movements.
- Pelvic floor exercises: Strengthening pelvic floor muscles through exercises such as Kegels, possibly with the assistance of a physical therapist.
Medical treatments
- Stool softeners and laxatives: Managing constipation with over-the-counter or prescribed medications to reduce straining.
- Biofeedback therapy: Techniques to improve bowel control and strength of pelvic floor muscles.
Surgical treatments
- Abdominal rectopexy: Surgical procedure to secure the rectum in its proper position using sutures or mesh, typically performed laparoscopically or robotically.
- Perineal surgery: Minimally invasive approaches through the perineum, such as Altemeier procedure (perineal rectosigmoidectomy) or Delorme procedure (resection of the prolapsed mucosa).
- Laparoscopic surgery: Minimally invasive abdominal surgery to correct prolapse and attach the rectum to the sacral bone.
- Combination procedures: Combining different techniques (such as resection rectopexy) to address both prolapse and other associated conditions like sigmoid resection for redundant colon.
Post-operative care
- Monitoring: Close monitoring in a healthcare facility for recovery and to manage any complications.
- Pain management: Administration of pain relief medications to ensure comfort during recovery.
- Wound care: Instructions on keeping the surgical area clean and allowing it to heal properly.
Follow-up care
- Regular check-ups: Routine follow-up with the surgical team to monitor healing and address any complications.
- Pelvic floor rehabilitation: Post-surgery exercises and physical therapy to strengthen pelvic floor muscles and prevent recurrence.
- Dietary guidance: Continued emphasis on a high-fiber diet and hydration to maintain regular bowel habits.
Potential risks and complications
Complications of untreated rectal prolapse
- Chronic discomfort and pain: Ongoing discomfort and difficulty with bowel movements.
- Incontinence: Increased risk of worsening bowel control issues.
- Ulceration and infection: Risk of ulcers and infections in the prolapsed tissue.
- Strangulation: Severe cases where the prolapsed rectum becomes trapped and loses blood supply, leading to tissue necrosis.
Surgical risks
- Infection: Risk of infection at the surgical site.
- Bleeding: Risk of bleeding during and after surgery.
- Pelvic organ injury: Potential for damage to nearby organs during surgery.
- Recurrence: Risk of prolapse recurring after surgery.
Long-term considerations
- Chronic constipation: Need for ongoing management of constipation to prevent recurrence.
- Scarring: Potential for scar tissue formation, which can affect bowel function.
Impact on quality of life
- Physical comfort: Addressing and managing rectal prolapse improves comfort during daily activities and bowel movements.
- Emotional and psychological impact: Support for managing embarrassment or anxiety related to rectal prolapse and its symptoms.
Rectal prolapse is a condition that can cause significant discomfort and lead to complications if not properly managed. Understanding the causes, symptoms, diagnostic methods, and treatment options is essential for effective care. If you experience symptoms of rectal prolapse, consulting with a health care provider will help develop a comprehensive treatment plan tailored to your specific needs and circumstances.
Frequently asked questions about rectal prolapse
The rectum is normal fixed inside the body and is connected to the anal canal. Rectal prolapse is a condition where the connections that hold the rectum inside weaken and the rectum can fall through the anus. Rectal prolapse may be associated with drainage of mucus, blood or stool, fecal incontinence, and can often times be uncomfortable or very painful. Rectal prolapse may happen as a result of straining on the toilet but can occur with very little pressure at random times.
Rectal prolapse affects about 2.5 out of 100,000 people. While this is a relatively rare condition, it is a very common issue treated at WashU Medicine. We see a high volume of people with rectal prolapse, meaning this is a normal health problem for us to help people manage. This problem is more frequent in women and tends to occur in patients over the age of 60, however, men and women of all ages can experience this problem.
Rectal prolapse can typically be seen by examining the anal canal when you feel the rectum has fallen out. This is usually most obvious after bowel movements and straining. The rectum may be able to be seen outside of the anus but sometimes the rectum will return back inside once straining stops. You may feel a bulge outside of the anus and it will look like a red or pink mass outside the anal canal. It is very hard to tell the difference between rectal prolapse and very enlarged hemorrhoids. If you have any concerns about either issue, a colorectal surgeon can help you get an accurate diagnosis and the treatment you need. Colorectal specialists at WashU Medicine offer surgical and nonsurgical treatments, depending on the severity of the issue.
