What is a rectal prolapse?
A rectal prolapse is where part or all of the wall of the rectum slides out of place and protrudes from the anus.
Initially, the rectum slips out when passing stool and then goes back in by itself. Without treatment, the rectum may stay out and need to be pushed back in manually.
Rectal prolapse is categorised based on severity:
- internal prolapse – the rectum has prolapsed but not through the anus (incomplete prolapse)
- mucosal prolapse – the inner lining of the rectum protrudes through the anus (partial prolapse)
- external prolapse – the full thickness of the rectum protruded through the anus (complete prolapse).
Women are much more likely than men to have a rectal prolapse.
What are the symptoms of rectal prolapse?
Symptoms of rectal prolapse include:
- pain and discomfort deep down in your abdomen
- rectal bleeding
- anal itchiness
- passing mucus
- a persistent urge to pass stool
- feeling like you can’t fully empty your bowel
- difficulty passing stool
- rectal tissue protruding from the anus
- needing a lot of toilet paper to clean yourself after passing stool
- faecal incontinence.
What causes rectal prolapse?
The exact cause of rectal prolapse isn’t known. There are several risk factors.
Rectal prolapse occurs mainly in women. It is usually related to:
- having another intestinal problem (e.g. constipation, colorectal cancer)
- weakness of pelvic floor muscles (due to age)
- weakened or damaged anal sphincter muscles from childbirth or surgery.
How is rectal prolapse diagnosed?
Rectal prolapse is usually diagnosed by examination.
Where the rectum goes back inside by itself after passing a bowel motion, you may be asked to bear down during examination to show the prolapse. When an internal prolapse is suspected, diagnostic tests may include ultrasound, special X-rays and measurement of the anorectal muscle activity (anorectal manometry).
Your doctor may want to some tests to check for other conditions such as colorectal cancer.
How is rectal prolapse treated?
Treatment depends on your age, the severity of the prolapse and whether other pelvic abnormalities are present.
Treatment options include conservative therapy and surgery.
Before trying other treatment, you might want to:
- push the prolapse back into place (if your doctor says it’s okay)
- avoid constipation by adding fibre to your diet and engaging in regular exercise
- doing pelvic floor exercises
- not strain when passing stool.
If your symptoms don’t improve, you may need surgery to secure the rectum into place.
Your specialist surgeon can reach the rectum through your abdomen or through your anus.
Abdominal surgery may be:
- open surgery – your surgeon makes a single large incision in your abdomen. She then moves your organs gently aside to reach the rectum. To stop it prolapsing, she secures it to the central bone of the pelvis (or the inner abdominal wall). Often the repair is reinforced with a piece of mesh.”
- laparoscopic or keyhole surgery – your surgeon makes several small incisions and inserts a thin tube with a light and a camera through one, and slender instruments through the others. The instruments are used to secure the rectum to the pelvic bone. Often the repair is reinforced with a piece of mesh.
During anal surgery, your surgeon gently pulls the prolapsed rectum out through the anus. She then removes that section of bowel, re-joins the ends and places it back through the anus. This surgery is easier to recover from than abdominal surgery. But recurrence of the prolapse is more likely.
Your rectal prolapse specialist can talk to you about the best option for your situation.