Rectal Prolapse

What is rectal prolapse? 

Rectal prolapse is a condition in which the rectum (the lower end of the colon, located just above the anus) drops downwards and turns inside out. In the early stage, the rectum stays inside the body, but as the condition worsens, it may protrude out through the anus. There is often weakness of the anal muscles, and this may result in leakage of stool or mucus. Rectal prolapse is more common in women than men.

What are the types of rectal prolapse?

• Partial prolapse (mucosal prolapse): Only the inner lining of the rectum (mucosa) pushes out through the anus. This typically happens during bowel movements.
• Complete prolapse: This involves the entire wall of the rectum sliding out through the anus. It may happen during bowel movements but can also occur while standing or walking.
• Internal prolapse (intussusception): In this case, the rectum folds in on itself but does not extend outside the anus. It is less visible and may be harder to diagnose than other types.

What are the symptoms of rectal prolapse?

The key symptom of rectal prolapse is the protrusion of the rectum through the anus, which may initially happen only during bowel movements. Other symptoms include:

• A feeling of incomplete bowel emptying
• Mucus discharge
• Rectal bleeding

Some individuals may also notice chronic constipation or a sensation of something falling out of the anus.

When should you see a doctor?

You should consult medical advice if you experience any symptoms of complications such as heavy rectal bleeding, a bulge from your rectum during or after bowel movements or difficulty controlling your bowels.

If the prolapsed rectum becomes persistent or painful or if the tissue remains outside the body, it is important to consult a healthcare professional for diagnosis and treatment.

How can you reduce the risk of rectal prolapse?

Although rectal prolapse cannot be completely prevented, measures can be taken to reduce the risk of the condition – such as adopting a healthy lifestyle that supports digestive health. Consuming sufficient fibre and staying hydrated aids in preventing constipation, which reduces straining. Regular physical activity helps maintain overall bowel function, and addressing any pelvic floor weakness or underlying conditions early can further reduce the risk of prolapse.

What causes rectal prolapse?

Several factors contribute to the development of rectal prolapse. 

• Repeated straining at stools
• Stresses during childbirth
• Ageing, which leads to the weakening of the tissues that support the rectum and the weakening of the muscles of the anus
• Neurological problems, such as spinal cord injury or spinal cord disease
  

In most cases, there is no single identifiable cause.

How is rectal prolapse diagnosed?

The condition can be diagnosed by your doctor. To demonstrate the prolapse, patients may be asked to "strain" as if having a bowel movement or to sit on the commode and "strain" prior to examination.

For earlier stages, an x-ray examination may be needed for the diagnosis. X-ray pictures are taken while the patient is having a bowel movement. X-rays also help your doctor in deciding whether surgery is useful and which operation is suitable.

Anorectal manometry may also be used. This test measures the strength of the muscles of the anus.

How is rectal prolapse treated?

Just treating the constipation and straining may not be enough once rectal prolapse has occurred. There are different types of surgery for rectal prolapse. Your doctor will help you decide which method is most suited for you.

Success depends on a few factors, including the strength of the anal muscles before surgery, the stage of the prolapse, the overall health of the patient and the type of surgery. A great majority of patients are completely relieved of symptoms, or are significantly helped, by the appropriate procedure.

References

1. Cervigni, M., Natale, F., & Padoa, A. (n.d.-a). Management of associated pelvic dysfunctions: External rectal prolapse and genital prolapse. Rectal Prolapse, 189–199. https://doi.org/10.1007/978-88-470-0684-3_25
   
2. Paterson, H. M., & Bartolo, D. C. (n.d.). Treatment of internal rectal prolapse by rectopexy. Rectal Prolapse, 57–62. https://doi.org/10.1007/978-88-470-0684-3_7
   
3. U.S. Department of Health and Human Services. (n.d.). Rectal prolapse - niddk. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract/rectal-prolapse