Rectal prolapse occurs when the rectum (the last section of the large intestine) falls from its normal position within the pelvic area and sticks out through the anus. (The word “prolapse” means a falling down or slipping of a body part from its usual position.)
The term “rectal prolapse” can describe three types of prolapse:
Rectal prolapse is common in older adults who have a long-term history of constipation or a weakness in the pelvic floor muscles. It is more common in women than in men, and even more common in women over the age of 50 (postmenopausal women), but occurs in younger people too. Rectal prolapse can also occur in infants – which could be a sign of cystic fibrosis – and in older children.
No. Rectal prolapse results from a slippage of the attachments of the last portion of the large intestine. Hemorrhoids are swollen blood vessels that develop in the anus and lower rectum. Hemorrhoids can produce anal itching and pain, discomfort and bright red blood on toilet tissue. Early rectal prolapse can look like internal hemorrhoids that have slipped out of the anus (i.e., prolapsed), making it difficult to tell these two conditions apart.
Rectal prolapse can occur as a result of many conditions, including:
The symptoms of rectal prolapse include the feeling of a bulge or the appearance of reddish-colored mass that extends outside the anus. At first, this can occur during or after bowel movements and is a temporary condition. However, over time – because of an ordinary amount of standing and walking – the end of the rectum may even extend out of the anal canal spontaneously, and may need to be pushed back up into the anus by hand.
Other symptoms of rectal prolapse include pain in the anus and rectum and bleeding from the inner lining of the rectum. These are rarely life-threatening symptoms.
Fecal incontinence is another symptom. Fecal incontinence refers to leakage of mucus, blood or stool from the anus. This occurs as a result of the rectum stretching the anal muscle. Symptoms change as the rectal prolapse itself progresses.
First, your doctor will take your medical history and will perform a rectal exam. You may be asked to “strain” while sitting on a commode to mimic an actual bowel movement. Being able to see the prolapse helps your doctor confirm the diagnosis and plan treatment.
Other conditions, such as urinary incontinence, bladder prolapse and vaginal/uterine prolapse, could be present along with rectal prolapse. Because of the variety of potential problems, urologists, urogynecologists and other specialists often team together to share evaluations and make joint treatment decisions. In this way, surgeries to repair any combination of these problems can be done at the same time.
Doctors can use several tests to diagnose rectal prolapse and other pelvic floor problems, and to help determine the best treatment for you. Tests used to evaluate and make treatment decisions include:
In some cases of very minor, early prolapse, treatment can begin at home with the use of stool softeners and by pushing the fallen tissue back up into the anus by hand. However, surgery is usually necessary to repair the prolapse.
There are several surgical approaches. The surgeon’s choice depends on patient’s age, other existing health problems, the extent of the prolapse, results of the exam and other tests and the surgeon’s preference and experience with certain techniques.
Abdominal and rectal (also called perineal) surgery are the two most common approaches to rectal prolapse repair.
Abdominal procedure refers to making an incision in the abdominal muscles to view and operate in the abdominal cavity. It is usually performed under general anesthesia and is the approach most often used in healthy adults.
The two most common types of abdominal repair are rectopexy (fixation [reattachment] of the rectum) and resection (removal of a segment of intestine) followed by rectopexy. Resection is preferred for patients who have severe constipation. Rectopexy can also be performed laparoscopically through small keyhole incisions, or robotically, making recovery much easier for patients.
Rectal procedures are often used in older patients and in patients who have more medical problems. Spinal anesthesia or an epidural (anesthesia that blocks pain in a certain part of the body) may be used instead of general anesthesia in these patients. The two most common rectal approaches are the Altemeier and Delorme procedures:
As with any surgery, anesthesia complications, bleeding and infection are always risks. Other risks and complications from surgeries to repair rectal prolapse include:
After surgery, constipation and straining should be avoided. Fiber, fluids, stool softeners and mild laxatives can be used.