What are the symptoms of rectal prolapse. What causes rectal prolapse to occur. How is rectal prolapse diagnosed and treated. Who is at risk for developing rectal prolapse. What complications can arise from untreated rectal prolapse. How can rectal prolapse be prevented or managed.

Understanding Rectal Prolapse: An Overview

Rectal prolapse is a condition where the rectum, the final portion of the large intestine, turns itself inside out and protrudes through the anus. This medical issue affects people of all ages, but it’s particularly common in women over 50 and young children under three. While the exact cause remains unknown, several risk factors have been identified, including chronic constipation, straining during bowel movements, and weakened pelvic floor muscles.

The severity of rectal prolapse can vary, ranging from internal prolapse (where the rectum has slipped but not emerged from the anus) to full-thickness external prolapse (where the entire rectum protrudes). Understanding the different types and stages of this condition is crucial for proper diagnosis and treatment.

Recognizing the Symptoms of Rectal Prolapse

Identifying rectal prolapse early can lead to more effective treatment and prevent complications. The symptoms can vary depending on the severity of the condition, but may include:

• Pain and discomfort in the lower abdomen
• Blood and mucus discharge from the anus
• Feeling of incomplete bowel emptying
• Difficulty passing stools
• Visible protrusion of rectal tissue through the anus
• Excessive use of toilet paper for cleaning after bowel movements
• Leakage of liquid feces
• Fecal incontinence or reduced bowel control

Do these symptoms always indicate rectal prolapse? Not necessarily. Some of these symptoms can be associated with other gastrointestinal conditions, which is why proper medical diagnosis is essential.

Types of Rectal Prolapse: From Mild to Severe

Rectal prolapse is classified into three main types based on its severity:

1. Internal prolapse: Also known as incomplete prolapse, this occurs when the rectum has slipped but not protruded through the anus.
2. Mucosal prolapse: In this type, only the inner lining of the rectum protrudes through the anus.
3. External prolapse: Also called complete or full-thickness prolapse, this is the most severe form where the entire thickness of the rectal wall protrudes through the anus.

Is it possible for rectal prolapse to progress from one type to another? Yes, without proper treatment, an internal prolapse can potentially develop into an external prolapse over time.

Unraveling the Causes and Risk Factors of Rectal Prolapse

While the exact cause of rectal prolapse remains elusive, several risk factors have been identified:

• Chronic constipation and straining during bowel movements
• Weakened pelvic floor and anal sphincter muscles
• Age-related muscle weakening, particularly in those over 65
• Genetic predisposition
• Parasitic infections (rare in developed countries)
• Conditions that increase abdominal pressure (e.g., benign prostatic hypertrophy, chronic obstructive pulmonary disease)
• Structural issues with rectal ligaments
• Congenital bowel problems (e.g., Hirschsprung’s disease)
• Prior lower back trauma or disc disease

Can lifestyle changes help prevent rectal prolapse? Indeed, maintaining a healthy diet rich in fiber, staying hydrated, and avoiding excessive straining during bowel movements can significantly reduce the risk of developing this condition.

Diagnosing Rectal Prolapse: From Physical Examination to Advanced Imaging

Accurate diagnosis of rectal prolapse is crucial for determining the most appropriate treatment plan. The diagnostic process typically involves:

1. Physical examination: A doctor may ask the patient to strain as if having a bowel movement to observe any prolapse.
2. Imaging tests: For suspected internal prolapse, ultrasound or special x-rays may be used.
3. Anorectal manometry: This test measures the strength of the anal sphincter muscles.
4. Additional tests: If rectal bleeding is present, further tests may be conducted to rule out other conditions like bowel cancer.

Why is it important to test young children with rectal prolapse for cystic fibrosis? Approximately 11% of children with rectal prolapse also have cystic fibrosis, making it crucial to screen for this condition in pediatric cases.

Potential Complications of Untreated Rectal Prolapse

Left untreated, rectal prolapse can lead to several complications:

• Damage to the rectal tissue, including ulceration and bleeding
• Incarceration, where the prolapsed rectum cannot be manually pushed back inside
• Strangulation of the rectum, reducing blood supply
• Gangrene of the strangulated rectal section

How quickly can these complications develop? The progression of complications can vary greatly between individuals, but prompt medical attention is always advisable to prevent these serious outcomes.

Treatment Options for Rectal Prolapse: From Conservative Management to Surgery

The treatment approach for rectal prolapse depends on various factors, including the patient’s age, the severity of the prolapse, and the presence of other pelvic abnormalities. Treatment options include:

1. Diet and lifestyle changes: Increasing fiber intake, staying hydrated, and regular exercise can help manage chronic constipation, often resolving rectal prolapse in young children.
2. Rubber band ligation: For cases of mucosal prolapse, surgical rubber bands may be used to secure the prolapsed tissue in place.
3. Surgery: Various surgical procedures can be performed to repair rectal prolapse, either through the abdomen or via the anus.

What factors determine the choice of surgical approach? The decision between abdominal and perineal surgical approaches depends on the patient’s overall health, age, and the severity of the prolapse. Abdominal procedures are generally more durable but may have a longer recovery time, while perineal surgeries are often preferred for older or higher-risk patients.

Abdominal Surgical Approaches

Abdominal surgeries for rectal prolapse involve accessing the rectum through an incision in the abdomen. These procedures typically aim to restore the normal anatomy by pulling the rectum back into place and securing it to the sacrum (lower spine). Common abdominal approaches include:

• Rectopexy: The rectum is lifted and attached to the sacrum using sutures or mesh.
• Resection rectopexy: A portion of the sigmoid colon is removed before performing a rectopexy, which can help address associated constipation.
• Laparoscopic or robotic-assisted procedures: These minimally invasive techniques can result in faster recovery and less postoperative pain.

Perineal Surgical Approaches

Perineal surgeries are performed through the anus and are generally considered less invasive than abdominal procedures. They may be preferred for older patients or those with significant medical comorbidities. Common perineal approaches include:

• Delorme’s procedure: The prolapsed rectal lining is removed, and the underlying muscle is plicated (folded and stitched).
• Altemeier procedure: The prolapsed rectum is removed, and the remaining rectum is reattached to the anal canal.

How effective are these surgical procedures? While success rates can vary, most patients experience significant improvement in symptoms and quality of life following surgery. However, there is a risk of recurrence, particularly with perineal approaches.

Prevention and Management of Rectal Prolapse

While not all cases of rectal prolapse can be prevented, several strategies can help reduce the risk and manage the condition:

1. Maintain a high-fiber diet: Consuming plenty of fruits, vegetables, and whole grains can help prevent constipation.
2. Stay hydrated: Adequate fluid intake is crucial for maintaining soft, easy-to-pass stools.
3. Exercise regularly: Physical activity can help improve bowel function and strengthen pelvic floor muscles.
4. Avoid straining: Use proper toilet posture and avoid spending excessive time on the toilet.
5. Pelvic floor exercises: Kegel exercises can help strengthen the muscles supporting the rectum.
6. Manage chronic cough: Treating underlying conditions that cause chronic coughing can help reduce abdominal pressure.

Can these preventive measures also help after surgical treatment? Absolutely. Adopting these lifestyle changes can significantly reduce the risk of recurrence following surgical repair of rectal prolapse.

Special Considerations for Pediatric Rectal Prolapse

Rectal prolapse in children, particularly those under three years of age, often resolves spontaneously without the need for surgical intervention. However, it’s crucial to address any underlying causes and implement appropriate management strategies:

• Dietary modifications: Increasing fiber intake and ensuring adequate hydration can help resolve constipation-related prolapse.
• Proper toilet training: Teaching children to avoid straining and prolonged sitting on the toilet is essential.
• Treatment of underlying conditions: Addressing issues such as parasitic infections or cystic fibrosis is crucial for long-term management.
• Manual reduction: Parents may be taught how to gently push the prolapsed rectum back in place if necessary.

When should parents seek medical attention for their child’s rectal prolapse? While occasional, self-resolving prolapse may not require immediate medical intervention, persistent or frequent episodes should be evaluated by a healthcare professional to rule out underlying conditions and determine the need for treatment.

Living with Rectal Prolapse: Coping Strategies and Support

Dealing with rectal prolapse can be challenging, both physically and emotionally. Here are some strategies to help cope with the condition:

1. Education: Understanding the condition can help alleviate anxiety and improve adherence to treatment plans.
2. Support groups: Connecting with others who have similar experiences can provide emotional support and practical advice.
3. Pelvic floor physiotherapy: Working with a specialized physiotherapist can help strengthen pelvic floor muscles and improve symptoms.
4. Stress management: Techniques such as mindfulness and relaxation exercises can help manage stress-related symptoms.
5. Adaptive clothing: Wearing comfortable, loose-fitting clothing can help reduce discomfort associated with prolapse.

How can family members support someone with rectal prolapse? Family members can provide emotional support, assist with lifestyle modifications, and help ensure adherence to treatment plans. Understanding and empathy are crucial in supporting a loved one with this condition.

The Role of Ongoing Medical Care

Regular follow-up with healthcare providers is essential for managing rectal prolapse effectively. This may include:

• Periodic physical examinations to assess the status of the prolapse
• Adjustments to treatment plans as needed
• Monitoring for potential complications or recurrence
• Addressing any new symptoms or concerns promptly

How often should follow-up appointments be scheduled? The frequency of follow-up visits will depend on the individual’s specific situation, including the severity of the prolapse and the chosen treatment approach. Your healthcare provider will recommend an appropriate follow-up schedule.

Emerging Research and Future Directions in Rectal Prolapse Treatment

The field of rectal prolapse management is continually evolving, with ongoing research aimed at improving diagnostic techniques, treatment options, and long-term outcomes. Some areas of current interest include:

• Advanced imaging techniques: Improved MRI and 3D ultrasound technologies may enhance the accuracy of diagnosis and surgical planning.
• Minimally invasive surgical innovations: Refinements in laparoscopic and robotic-assisted procedures may further reduce recovery times and improve outcomes.
• Biomaterials for rectopexy: Research into new materials for use in rectopexy procedures may lead to better long-term results and reduced recurrence rates.
• Stem cell therapies: Preliminary studies are exploring the potential of stem cells to strengthen weakened pelvic floor muscles.
• Genetic research: Investigations into genetic factors contributing to rectal prolapse may lead to new preventive strategies and targeted treatments.

What potential breakthroughs can we expect in rectal prolapse treatment in the coming years? While it’s difficult to predict specific breakthroughs, ongoing research suggests that we may see more personalized treatment approaches, improved surgical techniques, and potentially non-surgical options for managing rectal prolapse in the future.

The Importance of Patient Participation in Research

Patients with rectal prolapse can play a crucial role in advancing our understanding and treatment of this condition by participating in clinical trials and research studies. This participation can help:

1. Evaluate new diagnostic tools and treatment options
2. Improve our understanding of the long-term outcomes of various interventions
3. Identify factors that contribute to successful treatment and prevention of recurrence
4. Develop better quality-of-life measures for individuals with rectal prolapse

How can patients find out about ongoing research studies? Patients interested in participating in rectal prolapse research should discuss this with their healthcare providers, who can provide information about suitable clinical trials or research studies in their area.

Rectal prolapse – Better Health Channel

Actions for this page

Summary

Read the full fact sheet

• We do not know the exact cause of rectal prolapse, but risk factors include chronic constipation, straining to pass bowel motions, and weakened pelvic floor muscles.
• Treatment includes surgery, performed through the abdomen or via the anus, to tether the rectum into place.
• A diet that successfully treats constipation is often all that’s needed to cure rectal prolapse in young children.

The rectum is the last 20 cm or so of the large bowel. It is the temporary storage area for bowel motions. Rectal prolapse occurs when the rectum turns itself inside out and comes out through the anus. Without treatment, the rectum will eventually need to be pushed back in manually.

Women are six times more likely to suffer rectal prolapse than men. Children of both sexes under the age of three years are also commonly affected by rectal prolapse, although the prolapse tends to resolve by itself without the need for surgery.

In the early stages of rectal prolapse, a portion of the rectum slips out while passing a bowel motion, but it goes back inside by itself.

Symptoms of rectal prolapse

The symptoms of rectal prolapse depend on the severity, but can include:

• Pain and discomfort felt deep within the lower abdomen
• Blood and mucus from the anus
• The feeling of constipation, or that the rectum is never completely emptied after passing a motion
• Difficulties passing a bowel motion
• Protrusion of the rectum through the anus
• The need to use huge quantities of toilet paper to clean up following a bowel motion
• Leakage of liquefied faeces, particularly following a bowel motion
• Faecal incontinence, or reduced ability to control the bowels.

Types of rectal prolapse

Rectal prolapse is graded according to its severity, including:

• Internal prolapse – the rectum has prolapsed, but not so far as to slip through the anus. This is also known as incomplete prolapse
• Mucosal prolapse – the interior lining of the rectum protrudes through the anus
• External prolapse – the entire thickness of the rectum protrudes through the anus. This is also known as complete or full-thickness prolapse.

Causes of rectal prolapse

The exact cause of rectal prolapse is unknown, but risk factors include:

• Chronic constipation
• Straining to pass bowel motions
• Weakened pelvic floor muscles
• Weakened anal sphincter muscles
• Weakening of the muscles associated with ageing, since rectal prolapse is more common in people aged 65 years and over
• Genetic susceptibility, since it appears that some people with rectal prolapse have a blood relative with the same condition
• Parasitic infection, such as schistosomiasis – very rare in Australia
• Any condition that chronically increases pressure within the abdomen, such as benign prostatic hypertrophy, or chronic obstructive pulmonary disease (COPD)
• Structural problems with the ligaments that tether the rectum to its surrounds
• Congenital problems of the bowel, such as Hirschsprung’s disease or neuronal intestinal dysplasia
• Prior trauma to the lower back
• Disc disease in the lower back.

Complications of rectal prolapse

Complications of rectal prolapse include:

• Risk of damage to the rectum, such as ulceration and bleeding
• Incarceration – the rectum can’t be manually pushed back inside the body
• Strangulation of the rectum – the blood supply is reduced
• Death and decay (gangrene) of the strangulated section of the rectum.

Diagnosis of rectal prolapse

Rectal prolapse is diagnosed by examination. In cases where the rectum goes back inside by itself after passing a bowel motion, the person may have to bear down during examination by the doctor to show the prolapse in order to confirm the diagnosis.

In cases of suspected internal prolapse, diagnostic tests may include ultrasound, special x-rays and measurement of the anorectal muscle activity (anorectal manometry). If the person has experienced rectal bleeding, the doctor may want to do a number of tests to check for other conditions such as bowel cancer.

About 11 per cent of children with rectal prolapse have cystic fibrosis, so it is important to test young people for this condition too.

Treatment for rectal prolapse

Treatment depends on many individual factors, such as the age of the person, the severity of the prolapse, and whether or not other pelvic abnormalities are present (such as prolapsed bladder). Treatment options can include:

• Diet and lifestyle changes to treat chronic constipation – for example, more fruit, vegetables and wholegrain foods, increased fluid intake and regular exercise. This option is often all that’s needed to successfully treat rectal prolapse in young children
• Securing the structures in place with surgical rubber bands – in cases of mucosal prolapse
• Surgery.

Surgery for rectal prolapse

Surgery is sometimes used to secure the rectum into place. It can be performed through the person’s abdomen or via their anus. One operation involves tethering the rectum to the central bone of the pelvis (sacrum). Another operation is to remove the prolapsed part of the rectum and to rejoin the bowel to restore near-normal bowel function.

Although surgery through the abdomen may give better long-term results, older people may be advised to undergo surgical correction via the anus, since it is easier to recover from this procedure.

Before surgery for rectal prolapse

The day before surgery, you will be asked to fast, and may need to drink a special preparation to help flush out your bowels. Once you are in hospital, the anaesthetist will visit you to see what sort of anaesthetic is best for you. You may be given medication in the hours before the operation to prepare you for anaesthesia and make you feel drowsy.

Rectal prolapse operation procedure

The various types of surgery include:

• Laparotomy (open abdominal surgery) – the surgeon uses a single, large incision (cut) in the abdomen. Then the surgeon carefully moves aside the overlying organs. To stop the rectum prolapsing, it is lifted, pulled straight and stitched directly to the inner surface of the sacrum (central bone of the pelvis). Sometimes, a short length of bowel may be removed
• Laparoscopy (keyhole abdominal surgery) – laparoscopy may be possible in some cases. This involves inserting slender instruments through a number of small incisions in the abdomen. Recovery time following laparoscopy is usually quicker than open surgery
• Anal surgery – under anaesthesia, the surgeon gently pulls out the prolapsed bowel through the anus. The prolapsed section of bowel is usually removed and the structural damage repaired. The bowel is rejoined and returned back through the anus to restore normal bowel function and appearance.

Other forms of treatment for rectal prolapse

Surgery is the best option for severe rectal prolapse. Other possible forms of treatment may include:

• Lifestyle changes – including high-fibre diet, drinking plenty of water and getting regular exercise
• Change to toileting habits – such as not straining when trying to pass a bowel motion. This may require using fibre supplements or laxatives.

Immediately after surgery for rectal prolapse

After your operation for rectal prolapse or rectocele, things you can expect include:

• Hospital staff will observe and note your temperature, pulse, breathing and blood pressure.
• You will have an intravenous fluid line in your arm to replace fluids in your body.
• You will receive pain-relieving medications. Tell your nurse if you need more pain relief.
• You may have a catheter to drain off urine for the next day or so, or until you can empty your bladder by yourself.
• If you have a vaginal pack, this will be taken out later the same day or the day after surgery.
• You may be in hospital for three to six days following surgery.
• You will need to make follow-up appointments with your doctor.

Complications of surgery for rectal prolapse

Possible complications of surgery include:

• Allergic reaction to the anaesthetic
• Haemorrhage
• Infection
• Injury to nearby nerves or blood vessels
• Damage to other pelvic organs, such as the bladder or rectum
• Death (necrosis) of the rectal wall
• Recurrence of the rectal prolapse.

Taking care of yourself at home after surgery for rectal prolapse

Be guided by your doctor, but general suggestions include:

• Rest as much as you can.
• Avoid heavy lifting or straining for a few weeks.
• Don’t strain on the toilet.
• Take measures to prevent constipation, such as eating high-fibre foods and drinking plenty of water.
• After rectocele surgery, expect bloody vaginal discharge for about four weeks.
• Contact your doctor if you experience any unusual symptoms, such as difficulties with urination, heavy bleeding, fever, or signs of infection around the wound sites.
• You can expect to return to work around six weeks after surgery.
• Attend follow-up appointments with your surgeon.

Long-term outlook after surgery for rectal prolapse

While surgery through the abdomen gives better results, older people may be advised to undergo surgical correction of rectal prolapse via the anus, since this procedure is less stressful on the body.

Surgery gives good results in most cases of rectal prolapse, but some people may find that symptoms such as constipation or the inability to completely empty the bowels continue.

Unfortunately for women with rectocele, the problem will recur after surgery in about 10 per cent of cases.

Where to get help

• Your doctor
• Colorectal or general surgeon

Things to remember

• We do not know the exact cause of rectal prolapse, but risk factors include chronic constipation, straining to pass bowel motions, and weakened pelvic floor muscles.
• Treatment includes surgery, performed through the abdomen or via the anus, to tether the rectum into place.
• A diet that successfully treats constipation is often all that’s needed to cure rectal prolapse in young children.

This page has been produced in consultation with and approved
by:

This page has been produced in consultation with and approved
by:

Give feedback about this page

Was this page helpful?

More information

Content disclaimer

Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 30-09-2014

Rectal prolapse – Better Health Channel

Actions for this page

Summary

Read the full fact sheet

• We do not know the exact cause of rectal prolapse, but risk factors include chronic constipation, straining to pass bowel motions, and weakened pelvic floor muscles.
• Treatment includes surgery, performed through the abdomen or via the anus, to tether the rectum into place.
• A diet that successfully treats constipation is often all that’s needed to cure rectal prolapse in young children.

The rectum is the last 20 cm or so of the large bowel. It is the temporary storage area for bowel motions. Rectal prolapse occurs when the rectum turns itself inside out and comes out through the anus. Without treatment, the rectum will eventually need to be pushed back in manually.

Women are six times more likely to suffer rectal prolapse than men. Children of both sexes under the age of three years are also commonly affected by rectal prolapse, although the prolapse tends to resolve by itself without the need for surgery.

In the early stages of rectal prolapse, a portion of the rectum slips out while passing a bowel motion, but it goes back inside by itself.

Symptoms of rectal prolapse

The symptoms of rectal prolapse depend on the severity, but can include:

• Pain and discomfort felt deep within the lower abdomen
• Blood and mucus from the anus
• The feeling of constipation, or that the rectum is never completely emptied after passing a motion
• Difficulties passing a bowel motion
• Protrusion of the rectum through the anus
• The need to use huge quantities of toilet paper to clean up following a bowel motion
• Leakage of liquefied faeces, particularly following a bowel motion
• Faecal incontinence, or reduced ability to control the bowels.

Types of rectal prolapse

Rectal prolapse is graded according to its severity, including:

• Internal prolapse – the rectum has prolapsed, but not so far as to slip through the anus. This is also known as incomplete prolapse
• Mucosal prolapse – the interior lining of the rectum protrudes through the anus
• External prolapse – the entire thickness of the rectum protrudes through the anus. This is also known as complete or full-thickness prolapse.

Causes of rectal prolapse

The exact cause of rectal prolapse is unknown, but risk factors include:

• Chronic constipation
• Straining to pass bowel motions
• Weakened pelvic floor muscles
• Weakened anal sphincter muscles
• Weakening of the muscles associated with ageing, since rectal prolapse is more common in people aged 65 years and over
• Genetic susceptibility, since it appears that some people with rectal prolapse have a blood relative with the same condition
• Parasitic infection, such as schistosomiasis – very rare in Australia
• Any condition that chronically increases pressure within the abdomen, such as benign prostatic hypertrophy, or chronic obstructive pulmonary disease (COPD)
• Structural problems with the ligaments that tether the rectum to its surrounds
• Congenital problems of the bowel, such as Hirschsprung’s disease or neuronal intestinal dysplasia
• Prior trauma to the lower back
• Disc disease in the lower back.

Complications of rectal prolapse

Complications of rectal prolapse include:

• Risk of damage to the rectum, such as ulceration and bleeding
• Incarceration – the rectum can’t be manually pushed back inside the body
• Strangulation of the rectum – the blood supply is reduced
• Death and decay (gangrene) of the strangulated section of the rectum.

Diagnosis of rectal prolapse

Rectal prolapse is diagnosed by examination. In cases where the rectum goes back inside by itself after passing a bowel motion, the person may have to bear down during examination by the doctor to show the prolapse in order to confirm the diagnosis.

In cases of suspected internal prolapse, diagnostic tests may include ultrasound, special x-rays and measurement of the anorectal muscle activity (anorectal manometry). If the person has experienced rectal bleeding, the doctor may want to do a number of tests to check for other conditions such as bowel cancer.

About 11 per cent of children with rectal prolapse have cystic fibrosis, so it is important to test young people for this condition too.

Treatment for rectal prolapse

Treatment depends on many individual factors, such as the age of the person, the severity of the prolapse, and whether or not other pelvic abnormalities are present (such as prolapsed bladder). Treatment options can include:

• Diet and lifestyle changes to treat chronic constipation – for example, more fruit, vegetables and wholegrain foods, increased fluid intake and regular exercise. This option is often all that’s needed to successfully treat rectal prolapse in young children
• Securing the structures in place with surgical rubber bands – in cases of mucosal prolapse
• Surgery.

Surgery for rectal prolapse

Surgery is sometimes used to secure the rectum into place. It can be performed through the person’s abdomen or via their anus. One operation involves tethering the rectum to the central bone of the pelvis (sacrum). Another operation is to remove the prolapsed part of the rectum and to rejoin the bowel to restore near-normal bowel function.

Although surgery through the abdomen may give better long-term results, older people may be advised to undergo surgical correction via the anus, since it is easier to recover from this procedure.

Before surgery for rectal prolapse

The day before surgery, you will be asked to fast, and may need to drink a special preparation to help flush out your bowels. Once you are in hospital, the anaesthetist will visit you to see what sort of anaesthetic is best for you. You may be given medication in the hours before the operation to prepare you for anaesthesia and make you feel drowsy.

Rectal prolapse operation procedure

The various types of surgery include:

• Laparotomy (open abdominal surgery) – the surgeon uses a single, large incision (cut) in the abdomen. Then the surgeon carefully moves aside the overlying organs. To stop the rectum prolapsing, it is lifted, pulled straight and stitched directly to the inner surface of the sacrum (central bone of the pelvis). Sometimes, a short length of bowel may be removed
• Laparoscopy (keyhole abdominal surgery) – laparoscopy may be possible in some cases. This involves inserting slender instruments through a number of small incisions in the abdomen. Recovery time following laparoscopy is usually quicker than open surgery
• Anal surgery – under anaesthesia, the surgeon gently pulls out the prolapsed bowel through the anus. The prolapsed section of bowel is usually removed and the structural damage repaired. The bowel is rejoined and returned back through the anus to restore normal bowel function and appearance.

Other forms of treatment for rectal prolapse

Surgery is the best option for severe rectal prolapse. Other possible forms of treatment may include:

• Lifestyle changes – including high-fibre diet, drinking plenty of water and getting regular exercise
• Change to toileting habits – such as not straining when trying to pass a bowel motion. This may require using fibre supplements or laxatives.

Immediately after surgery for rectal prolapse

After your operation for rectal prolapse or rectocele, things you can expect include:

• Hospital staff will observe and note your temperature, pulse, breathing and blood pressure.
• You will have an intravenous fluid line in your arm to replace fluids in your body.
• You will receive pain-relieving medications. Tell your nurse if you need more pain relief.
• You may have a catheter to drain off urine for the next day or so, or until you can empty your bladder by yourself.
• If you have a vaginal pack, this will be taken out later the same day or the day after surgery.
• You may be in hospital for three to six days following surgery.
• You will need to make follow-up appointments with your doctor.

Complications of surgery for rectal prolapse

Possible complications of surgery include:

• Allergic reaction to the anaesthetic
• Haemorrhage
• Infection
• Injury to nearby nerves or blood vessels
• Damage to other pelvic organs, such as the bladder or rectum
• Death (necrosis) of the rectal wall
• Recurrence of the rectal prolapse.

Taking care of yourself at home after surgery for rectal prolapse

Be guided by your doctor, but general suggestions include:

• Rest as much as you can.
• Avoid heavy lifting or straining for a few weeks.
• Don’t strain on the toilet.
• Take measures to prevent constipation, such as eating high-fibre foods and drinking plenty of water.
• After rectocele surgery, expect bloody vaginal discharge for about four weeks.
• Contact your doctor if you experience any unusual symptoms, such as difficulties with urination, heavy bleeding, fever, or signs of infection around the wound sites.
• You can expect to return to work around six weeks after surgery.
• Attend follow-up appointments with your surgeon.

Long-term outlook after surgery for rectal prolapse

While surgery through the abdomen gives better results, older people may be advised to undergo surgical correction of rectal prolapse via the anus, since this procedure is less stressful on the body.

Surgery gives good results in most cases of rectal prolapse, but some people may find that symptoms such as constipation or the inability to completely empty the bowels continue.

Unfortunately for women with rectocele, the problem will recur after surgery in about 10 per cent of cases.

Where to get help

• Your doctor
• Colorectal or general surgeon

Things to remember

• We do not know the exact cause of rectal prolapse, but risk factors include chronic constipation, straining to pass bowel motions, and weakened pelvic floor muscles.
• Treatment includes surgery, performed through the abdomen or via the anus, to tether the rectum into place.
• A diet that successfully treats constipation is often all that’s needed to cure rectal prolapse in young children.

This page has been produced in consultation with and approved
by:

This page has been produced in consultation with and approved
by:

Give feedback about this page

Was this page helpful?

More information

Content disclaimer

Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 30-09-2014

Rectal prolapse – causes, symptoms and treatment

Rectal prolapse (rectal prolapse, pelvic floor prolapse)

Rectal prolapse is a condition where the rectum or part of it loses its proper position inside the body, becomes mobile, stretches and exits through the anus. Prolapse of the rectum is divided into two types: internal (hidden) and external. The internal prolapse of the rectum differs from the external one in that the rectum has already lost its position, but has not yet come out. Prolapse of the rectum is often accompanied by weakness of the muscles of the anal canal, which entails the incontinence of gases, feces and mucus.

In women, the main factors in the development of rectal prolapse are pregnancy and childbirth. The prerequisites for the onset of the disease in men may be regular physical activity or the habit of strong straining.

Prolapse of the rectum usually does not cause pain at the very beginning of the disease. The main problems with rectal prolapse for patients are the feeling of discomfort and a foreign body in the anus, as well as an unaesthetic appearance, which significantly impairs the quality of human life.

Rectal prolapse usually responds well to treatment and has a low recurrence rate (recurrence) of only about 15%. Complications in treatment usually occur when the patient seeks specialized help late and tries to self-diagnose and treat. As a result of these actions – lost time for success in treatment. If no treatment is taken, part of the prolapsed intestine will gradually increase, in addition, the anal sphincter will stretch, and the likelihood of damage to the pelvic nerves will also increase. All this entails the following complications:0007

• Ulcers of the mucous membrane of the rectum.
• Tissue necrosis (necrosis) of the rectal wall.
• Bleeding.
• Incontinence of gases, mucus and feces.

The length of time during which these changes occur varies widely and differs from person to person, no physician can give an exact time frame for these serious disturbances to occur.

Normal

Dropout

Rectal prolapse and hemorrhoids

One of the common reasons why a patient does not see a doctor immediately after a problem occurs is the outward similarity of the manifestation of the disease with hemorrhoids, which they try to cure on their own – with suppositories and ointments. In fact, rectal prolapse and hemorrhoids are completely different diseases that outwardly may indeed seem similar due to the flow of tissue from the anal canal. Only with hemorrhoids, hemorrhoidal tissue falls out, and with rectal prolapse, part of the rectum. Also, both diseases have some similar symptoms, such as bleeding.

It is important to remember that incorrect diagnosis and incorrect treatment will never lead to the expected positive effect, and in some cases will exacerbate the problem.

Causes of the disease

What is the cause of rectal prolapse?

• Anything that increases pressure inside the abdomen can cause rectal prolapse. Constipation, diarrhea, prostatic hyperplasia (straining when urinating), pregnancy and childbirth, persistent cough.
• Injury to the anus, pelvic floor muscles, spinal nerves, pelvic nerves from previous surgery or trauma.
• Infections of the intestines with certain types of germs called parasites (such as amoebiasis and schistosomiasis).
• Certain disorders of the nervous system, such as multiple sclerosis.
• Mental health conditions associated with constipation such as: depression, anxiety, a side effect of medications used to treat mental disorders.

Symptoms of rectal prolapse

• The most common symptom that should alert you is the feeling of a foreign body in the anus coming out of the anus. In the early stages, this may occur during straining, but as the condition progresses, it may occur when coughing, sneezing, standing up, walking.
  In the early stages, when the prolapse is relatively minor, manual manipulation (fingering the bowel inward) will be successful, but over time this will become impossible.
• Sensation of incomplete emptying of the bowels – usually occurs in case of latent (internal) prolapse of the rectum.
• Fecal incontinence resulting in soiled clothing. Incontinence of gas, loose and hard stools, or mucus/blood discharge may also occur.
• Constipation occurs in up to 30-50% of patients with rectal prolapse. Constipation can occur due to congestion of the rectum, creating a blockage that gets worse with exertion.
• Pain and discomfort in the anus.
• Bleeding – Over time, the prolapsed mucosa can become thick and ulcerated, causing bleeding.

Diagnosis

In most cases, an experienced doctor will be able to make a diagnosis at the initial examination. However, there are additional research methods to assess the severity of the disease and help in the correct choice of one or another method of treatment.

Tests that may be required to determine the severity of rectal prolapse:

• Anal electromyography. This test determines if nerve damage is causing the anal sphincters to not work properly. It also deals with the coordination of the rectum and anal muscles.
• Anal manometry. This test examines the strength of the anal sphincter muscles. The study allows you to evaluate the function of holding.
• Transrectal ultrasound. E This test helps evaluate the shape and structure of the anal sphincter muscles and surrounding tissues.
• Proctography (defecography). This test evaluates how well the rectum holds stool and how well the rectum empties.
• Colonoscopy. Allows you to visually inspect the entire colon and helps identify any problems.

Our Clinic has all the necessary diagnostic services. We also work closely with urologists and gynecologists from other departments of Sechenov University, which allows us to approach the issue of treating rectal prolapse in a multidisciplinary manner, that is, jointly.

Treatment of rectal prolapse

In our Clinic, the whole spectrum of treatment of rectal prolapse is performed. Based on the stage of the disease and its manifestations, our specialists select the most optimal method of treatment. It is important to understand that rectal prolapse is a complex disease, the treatment of which is impossible without surgical intervention. For the treatment of rectal prolapse, our Clinic uses the following surgical techniques:

Abdominal operations (operations through the abdominal cavity)

1. The operation of rectosacropexy – for it, a mesh allograft (alloprosthesis) is used, which holds the intestine in a given position. During the operation, the rectum is mobilized to the level of the muscles that lift the anus, then the rectum is pulled up and fixed to the presacral fascia, located between the sacrum and the rectum, using a mesh allograft.

2. Kümmel’s operation is the fixation of the previously mobilized rectum to the promontory of the sacrum with interrupted sutures.

These operations can be performed either openly through incisions (laparotomy) or laparoscopically through small incisions.

Transanal operations (operations through the anal canal)

1. Delorme operation is the removal (resection) of the mucous membrane of the prolapsed part of the intestine with the formation of a muscular cuff that holds the intestine, protecting it from prolapse.

2. Altmeer operation — resection of the rectum or its prolapsed area with the formation of a colonanal anastomosis – attachment of the colon to the anal canal.

Surgical treatment in most cases allows patients to completely get rid of the symptoms of rectal prolapse. The success of treatment depends on the type of prolapse – internal or external, on the general condition of the patient and on the degree of neglect of the disease. Patients may need some time to restore the functions of the gastrointestinal tract. After the operation, it is important to control the stool, avoid constipation and severe straining.

Rectocele: symptoms, diagnosis, treatment, surgery

Rectocele

• Description
• Organization of treatment
• Cost of treatment

Description

Unfortunately, this historical definition does not quite correctly describe the clinical situation. Yes, indeed, for the most part, part of the rectum is hidden behind the protruding back wall of the vagina. At the same time, in some patients, loops of the small intestine or omentum protrude through the back wall. In this case, there is already a posterior enterocele. It should also be noted that there is often a combined problem, when both the loops of the small intestine and the rectum descend (recto-enterocele).

Symptoms

The symptoms of a rectocele depend on the organ that descends along with the posterior wall of the vagina. In principle, all symptoms can be divided into two groups:

• Symptoms associated with prolapse of the rectum: difficult defecation, the need to squeeze feces out of the protrusion of the posterior wall of the vagina, the need to independently (with a finger through the anus) empty the formed “pocket” in the rectum, defecation in portions, gas and stool incontinence (when combined with damage to the sphincter of the rectum).
• Specific symptoms arising from the prolapse of the loops of the small intestine and omentum are either completely absent or are expressed in pulling sensations in the lower abdomen, bloating and flatulence.

Common to both groups is the feeling of a foreign body in the vagina, trauma to the prolapsed mucosa when walking, dryness of the vaginal mucosa, and discomfort during sexual intercourse. Given the fact that the contents of the hernial protrusion can be heterogeneous, the symptoms are also often mixed.

Causes

The causes of rectocele are the same as in other forms of prolapse: childbirth and pregnancy, heavy physical exertion, chronic constipation and of course the hereditary factor. Despite this, it is with this type of vaginal prolapse that childbirth and constipation play a special role.

The first factor is especially important in the case of episiotomy (perineal incision during childbirth) and perineal ruptures (large fetus, rapid (very fast) delivery, incorrect obstetric care).

At this moment, the main “defender” of the posterior wall of the vagina suffers – the perineum and pelvic floor muscles, without them, the entire load falls on the thin fascia that separates the vagina and the rectum. That is why any surgical treatment always includes reconstruction of the perineum. The second most important factor is chronic constipation.

In the presence of this pathology, the supporting structures of the posterior wall experience constant high loads, as a result of which a rupture of the fascia occurs, through which part of the rectum exits.

Diagnostics

Diagnosis of rectocele consists in collecting patient complaints, clarifying the history of the disease and life. This allows you to determine the causes of the disease and suggest the existing anatomical defects of the pelvic floor. Next, a standard gynecological examination is performed, which gives an idea of ​​the degree of prolapse and the condition of the perineum. In total, there are four degrees of rectocele:

• 1 degree – when there is a slight prolapse, which is determined only during a gynecological examination and does not reach the entrance to the vagina by more than 1 cm;
• Grade 2 – when the posterior wall prolapse slightly does not reach the entrance to the vagina or falls below it, but not more than 1 cm;
• Grade 3 – in this case, the rectocele descends more than 1 cm from the entrance to the vagina, but not more than 5-7 cm;
• Grade 4 – complete eversion of the posterior wall of the vagina.

To clarify what exactly comes out along with the back wall of the vagina, a gynecological examination is always supplemented by a digital rectal examination – examination of the rectum with a finger through the anus.

Treatment

Treatment of rectocele includes both conservative and surgical methods. The first group includes training of the pelvic floor muscles, aimed at increasing their tone. Exercises can be effective only in the initial stages of prolapse and in patients with preserved muscular apparatus. This type of treatment can show real results in young women, especially in the first year after childbirth. A separate issue is the correctness of the exercises (it is not entirely clear what needs to be reduced and whether it is reduced), on which their effectiveness depends.

For control, biofeedback devices (BFB – therapy) have been created, which can increase the effectiveness of training several times. Another option for non-surgical treatment is pessaries. This is a whole group of devices of various shapes and sizes, made of rubber or silicone. The pessary is inserted into the vagina and blocks the way out for the protruding organs.

Unfortunately, this device causes chronic inflammation, discomfort and requires regular changes, which means visiting a gynecologist.

Operation

Video lecture for patients and colleagues. Prolapse of the uterus, bladder, rectum: symptoms, diagnosis, treatment, surgery. urologist, MD Shkarupa Dmitry Dmitrievich

The main method of treatment of rectocele is surgical. Moreover, both gynecologists and proctologists (transanal reconstruction) deal with this pathology. However, according to international standards, the vaginal route is more preferable, as it is more effective and safer. The operation for rectocele is to restore the defect of the fascia (colporrhaphy) between the rectum and the vagina, as well as the reconstruction of the damaged structures of the perineum.

It has been proven that the use of synthetic prostheses in this case does not improve the results, but significantly increases the risk of complications.

During the operation, it is very important to correctly collect the damaged fascia and perineum, excise old scars, otherwise pain may occur, including during sexual contact, as well as problems with defecation. Moreover, the cosmetic effect will also largely depend on the experience of the surgeon.

Organization of treatment

Hospitalization for the purpose of surgical treatment is carried out according to the principle “one window” . It is enough for the patient (or the person representing him) to write a letter with the wording of his question. At any time (both before hospitalization and after), you can ask questions of interest to the staff of the department.

CHI and VMP treatment

Citizens of the Russian Federation can receive free treatment under the CHI program for most diseases

No matter where you live

80% of patients come to us from the regions of the Russian Federation and countries near and far abroad

Many years of experience

Every year more than 3000 operations of any complexity are performed in the Department of Urology

At any time (both before hospitalization and after), you can ask questions of interest to the staff of the department.

1. Online consultation with a specialist

The organization of hospitalization for the purpose of surgical treatment is carried out according to the principle of “one window”. To do this, it is enough for the patient (or the person representing him) to write a letter with the wording of his question.

Write a letter

2. Appointment of the date of hospitalization

After the consultation, our administrator will contact you within a few days to make an appointment for hospitalization.

3. Examination before hospitalization

Preoperative examination should be carried out only after the approval of the date of hospitalization. You can get most of the examinations at the antenatal clinic or polyclinic at the place of residence free of charge, under the CHI policy.

If in your locality there is no opportunity to be adequately examined – do it in the regional center, if everything cannot be done within the framework of compulsory medical insurance (under the policy) – do it in paid laboratories (clinics).

NOT LATE THAN 14 DAYS before hospitalization, you must send SCANS (not photos) of the test results to the email address: [email protected]

4. Hospitalization in department

10 days before surgery withdrawal of drugs that affect blood clotting (aspirin, Plavix, warfarin, etc.