What are the causes of rectal prolapse. How is rectal prolapse diagnosed. What are the treatment options for rectal prolapse. Who is most at risk for developing rectal prolapse. What complications can arise from untreated rectal prolapse. How effective is surgery for treating rectal prolapse.

Understanding Rectal Prolapse: Causes, Types, and Risk Factors

Rectal prolapse is a condition where the rectum, the final portion of the large intestine, turns inside out and protrudes through the anus. While the exact cause remains unknown, several risk factors have been identified:

• Chronic constipation
• Straining during bowel movements
• Weakened pelvic floor muscles
• Weakened anal sphincter muscles
• Advanced age (more common in those 65 and older)
• Genetic predisposition
• Certain medical conditions (e.g., parasitic infections, benign prostatic hypertrophy, chronic obstructive pulmonary disease)
• Structural issues with rectal ligaments
• Congenital bowel problems
• Lower back trauma or disc disease

Rectal prolapse is classified into three main types:

1. Internal prolapse (incomplete prolapse): The rectum has prolapsed but not through the anus
2. Mucosal prolapse: Only the interior lining of the rectum protrudes through the anus
3. External prolapse (complete or full-thickness prolapse): The entire thickness of the rectum protrudes through the anus

Can certain demographics be more susceptible to rectal prolapse? Indeed, women are six times more likely to experience rectal prolapse than men. Additionally, children of both sexes under three years old are commonly affected, although in most cases, the condition resolves on its own without surgical intervention.

Recognizing the Symptoms of Rectal Prolapse

The severity of rectal prolapse can vary, but common symptoms include:

• Deep abdominal pain and discomfort
• Blood and mucus discharge from the anus
• Feeling of incomplete bowel emptying
• Difficulty passing bowel movements
• Visible protrusion of the rectum through the anus
• Excessive use of toilet paper for cleaning after bowel movements
• Leakage of liquefied feces, particularly after defecation
• Fecal incontinence or reduced bowel control

Is rectal prolapse always visible? Not necessarily. In early stages, a portion of the rectum may slip out during bowel movements but retract on its own. As the condition progresses, manual repositioning may become necessary.

Diagnosing Rectal Prolapse: Methods and Considerations

Diagnosing rectal prolapse typically involves a physical examination. In cases where the prolapse retracts spontaneously after bowel movements, the patient may need to bear down during the examination to demonstrate the condition.

For suspected internal prolapse, additional diagnostic tests may be employed:

• Ultrasound
• Specialized X-rays
• Anorectal manometry (measurement of anorectal muscle activity)

If rectal bleeding is present, further tests may be conducted to rule out other conditions such as bowel cancer. It’s worth noting that approximately 11% of children with rectal prolapse have cystic fibrosis, making it crucial to test young patients for this condition as well.

How can healthcare providers differentiate between rectal prolapse and hemorrhoids? While both conditions can involve tissue protruding from the anus, rectal prolapse typically presents as a circular protrusion, while hemorrhoids appear more localized and lumpy.

Treatment Options for Rectal Prolapse: From Conservative Approaches to Surgery

The treatment of rectal prolapse is tailored to individual factors, including the patient’s age, prolapse severity, and the presence of other pelvic abnormalities. Treatment options include:

1. Diet and lifestyle changes: This approach is often sufficient for treating rectal prolapse in young children. It involves increasing intake of fruits, vegetables, and whole grains, ensuring adequate hydration, and engaging in regular exercise to address chronic constipation.
2. Rubber band ligation: In cases of mucosal prolapse, surgical rubber bands may be used to secure the prolapsed tissue in place.
3. Surgery: Various surgical procedures can be employed to correct rectal prolapse, depending on the individual case.

Are there any non-invasive treatments for rectal prolapse? While surgery is often necessary for complete resolution, conservative measures such as dietary changes and pelvic floor exercises can be beneficial, especially in mild cases or as a complementary approach to surgery.

Surgical Interventions for Rectal Prolapse: Techniques and Considerations

Surgery is often the definitive treatment for rectal prolapse, especially in cases that don’t respond to conservative measures. Surgical approaches can be broadly categorized into two types:

1. Abdominal Procedures

These surgeries are performed through incisions in the abdomen and include:

• Rectopexy: The rectum is lifted and secured to the sacrum (lower back bone) using stitches or mesh.
• Resection: A portion of the sigmoid colon is removed, and the remaining colon is attached to the rectum.
• Combination procedures: Some surgeries combine rectopexy with bowel resection for optimal results.

2. Perineal Procedures

These surgeries are performed through the anus and include:

• Altemeier procedure: The prolapsed rectum is removed, and the remaining rectum is reattached to the anus.
• Delorme procedure: The mucosal layer of the prolapsed rectum is removed, and the muscular layer is folded and stitched back in place.

What factors determine the choice of surgical approach? The selection of surgical technique depends on various factors, including the patient’s age, overall health, prolapse severity, and the surgeon’s expertise. Abdominal procedures are generally preferred for younger, healthier patients due to their lower recurrence rates, while perineal procedures may be more suitable for older or higher-risk patients due to their less invasive nature.

Potential Complications of Rectal Prolapse and Post-Treatment Considerations

Untreated rectal prolapse can lead to several complications:

• Damage to the rectum, including ulceration and bleeding
• Incarceration: The prolapsed rectum becomes trapped outside the body
• Strangulation: Blood supply to the prolapsed rectum is compromised
• Gangrene: Death and decay of the strangulated rectal tissue

Post-treatment, patients may experience temporary issues such as constipation or incontinence. These symptoms typically improve with time and proper management. Pelvic floor exercises and dietary modifications can aid in recovery and prevent recurrence.

How long does recovery typically take after rectal prolapse surgery? Recovery time varies depending on the surgical approach and individual factors. Most patients can return to normal activities within 4-6 weeks, although full recovery may take several months. It’s crucial to follow post-operative instructions carefully to ensure optimal healing and prevent complications.

Prevention Strategies and Long-Term Management of Rectal Prolapse

While not all cases of rectal prolapse can be prevented, certain strategies may help reduce the risk or manage the condition long-term:

• Maintain a high-fiber diet to prevent constipation
• Stay hydrated by drinking plenty of water
• Avoid straining during bowel movements
• Practice pelvic floor exercises to strengthen the muscles
• Manage chronic cough or other conditions that increase abdominal pressure
• Seek prompt medical attention for persistent digestive symptoms

For those who have undergone treatment, regular follow-up with healthcare providers is essential to monitor for recurrence and address any ongoing symptoms.

Can lifestyle changes alone prevent rectal prolapse recurrence? While lifestyle modifications are crucial in managing rectal prolapse and reducing the risk of recurrence, they may not be sufficient in all cases. Some individuals may require ongoing medical management or repeat surgical intervention, especially if there are underlying anatomical or physiological factors contributing to the condition.

Special Considerations: Rectal Prolapse in Children and Elderly Patients

Rectal prolapse presents unique challenges in different age groups:

Children

In young children, rectal prolapse is often self-limiting and can be managed conservatively. Key points include:

• Dietary modifications to address constipation
• Proper toilet training to avoid straining
• Monitoring for underlying conditions like cystic fibrosis
• Surgical intervention only if conservative measures fail

Elderly Patients

Older adults may face additional challenges in managing rectal prolapse:

• Higher risk of complications due to weakened tissues and comorbidities
• Need for less invasive treatment options
• Importance of addressing underlying conditions that may contribute to prolapse
• Focus on improving quality of life and maintaining independence

How does the approach to treating rectal prolapse differ between children and elderly patients? The primary difference lies in the initial management strategy. For children, conservative measures are often preferred and frequently successful. In elderly patients, while conservative approaches are still considered, surgical intervention may be necessary sooner due to the chronic nature of the condition and the increased risk of complications. The choice of surgical technique also varies, with less invasive procedures often favored for older adults to minimize surgical risks.

Understanding the nuances of rectal prolapse across different age groups is crucial for healthcare providers to deliver optimal, patient-centered care. By tailoring treatment approaches to the specific needs and circumstances of each individual, better outcomes can be achieved, improving quality of life and reducing the risk of complications associated with this challenging condition.

Rectal prolapse – Better Health Channel

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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.

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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: Symptoms, Causes, Treatment, Surgery

Written by WebMD Editorial Contributors

• What Is Rectal Prolapse?
• Types of Rectal Prolapse
• Rectal Prolapse Symptoms
• Rectal Prolapse Causes
• Rectal Prolapse Risk Factors
• Rectal Prolapse Diagnosis
• Rectal Prolapse Treatment
• Rectal Prolapse Prevention
• Rectal Prolapse Complications
• More

Prolapse is when any body part slips or falls down from its normal position. Rectal prolapse is when your rectum — the last section of your large intestine — drops down or slides out of your anus. While that may sound scary, it’s typically not considered a medical emergency. However, the longer you have the condition, the worse it can get. Living with rectal prolapse can cause embarrassment and affect your quality of life.

If you feel like something just isn’t right when you go to the bathroom, or try to poop, you shouldn’t ignore it or make light of it. Your doctor can diagnose rectal prolapse and suggest treatment to fix it.

There are three types of prolapse:

• External prolapse: The entire rectum sticks out of your anus.
• Mucosal prolapse: Part of the rectal lining pokes out of your anus.
• Internal prolapse: The rectum has started to drop but is not yet sticking out of your anus.

If you feel like you’re sitting on a ball after pooping, or if you notice that you have something sticking out of the opening (your anus) where you poop, you could have rectal prolapse.

Typically, you’ll first experience rectal prolapse after you have a bowel movement. The first time, or first few times, the rectum may return inside on its own. Later, you may feel like something has fallen out of your body, or you just feel something down there that isn’t normal. In those cases, you may be able to push the rectum back in yourself.

Additional symptoms of rectal prolapse can include:

• Feeling a bulge outside your anus
• Seeing a red mass outside your anal opening
• Pain in the anus or rectum
• Bleeding from the rectum
• Leaking blood, poop, or mucus from the anus

Early on, rectal prolapse may look like hemorrhoids slipping out of your anal opening, but these are two different conditions. Hemorrhoids are swollen blood vessels in your anus or lower rectum that may cause itching, pain, and blood on the toilet paper when you wipe after you poop. Your doctor can diagnose whether you have rectal prolapse or hemorrhoids.

A variety of things can cause the condition, including:

• Long-term history of diarrhea or constipation
• Long-term history of having to strain when you poop
• Old age, which weakens muscles and ligaments in the rectal area
• Previous injury to the anal or hip area
• Nerve damage that affects your muscles’ ability to tighten and loosen, which could be caused by pregnancy, vaginal childbirth complications, anal sphincter paralysis, or injury to your spine or back
• Neurological problems, such as spinal cord disease or spinal cord transection

More women develop rectal prolapse than men, especially women older than 50. In general, older people who have had a history of constipation or problems with their pelvic floor have a higher chance of having the problem.

Any of these health conditions could put you at higher risk for rectal prolapse:

• Chronic constipation
• Always have to strain to poop
• Lower back injury or disc disease
• Muscle weakness in your anus or pelvic floor
• Someone in your family also had rectal prolapse
• Parasitic infections like schistosomiasis
• Chronic obstructive pulmonary disorder (COPD)
• Benign prostatic hypertrophy
• Any injury or problems with ligaments that keep your rectum attached to the intestinal wall
• Congenital bowel disorders like Hirschsprung’s disease or neuronal intestinal dysplasia

Your doctor can do a rectal exam. While you may hesitate to do this, your doctor may ask you to sit on a toilet and poop or at least try to go. This is helpful because it allows your doctor to see the prolapse.

You may need some other, more advanced tests to diagnose rectal prolapse, especially if you have other related conditions:

• Anal electromyography (EMG):This test checks to see if nerve damage is causing your anal sphincter problems.
• Anal manometry: A thin tube is inserted into your rectum to test muscle strength.
• Anal ultrasound: A probe inserted into your anus and rectum is used to examine muscles and tissues.
• Pudendal nerve terminal motor latency test: It checks your pudendal nerves, which you use to control bowel movements.
• Proctography:X-ray videos of your rectum during a poop show how well it holds and releases feces.
• Colonoscopy: A long tube inserted into your rectum with a tiny camera at the end can show the inside of your intestines and look for any problems that may be causing your prolapse.
• Proctosigmoidoscopy:This test also uses a long tube with a camera on the end. It’s inserted deep into your intestines to look for inflammation, scarring, or a tumor.
• MRI: Imaging scan examines all of the organs in your pelvic area.

The most common treatment for rectal prolapse is surgery to put the rectum back in place, and there are several types. The kind of surgery your doctor recommends will depend on factors such as your overall health, age, and how serious your condition is. The two most common types of surgery:

• Abdominal: This type of surgery can be done either with a large incision or using laparoscopy, which uses small cuts and a camera attached to an instrument so the surgeon can see what needs to be done and if there are any additional issues that need to be fixed.
• Perineal: Also called rectal repair, this approach may be used if you are older or have other medical problems. This type of surgery can involve the inner lining of the rectum or the portion of the rectum extending out of the anus.

If your rectal prolapse is very minor and it is caught early, your doctor might have you treat it by taking stool softeners to make it easier to go to the bathroom and by pushing the rectum’s tissue back up the anus by hand. But, typically, you will eventually need to have surgery to fix rectal prolapse.

To prevent rectal prolapse, try not to strain when you poop. Try these tips to ease or prevent constipation that leads to straining:

• Get more fiber in your diet. Aim for at least five servings of fruits and veggies each day.
• Drink 6 to 8 glasses of water a day.
• Get regular exercise.
• Keep your weight at a healthy level or lose weight if you need to.
• If you have constipation often, talk to your doctor. They may direct you to take a stool softener or laxative.

Avoid heavy lifting, as this could put pressure on your bowel muscles.

Rectal prolapse, if it’s not treated, could lead to these complications:

• Rectal damage like ulceration or bleeding
• Your rectum can’t be manually pushed back up inside you
• Strangulation, or the blood supply in your rectum is reduced
• Gangrene, or the strangulated rectal tissue decays and dies

Top Picks

Bowel prolapse (rectal prolapse)

The human intestine is characterized by a large length, as a rule, the length is four meters. The final section of the intestine is represented by the rectum, in which feces are formed and their output to the outside. According to the norm, the rectum should be tightly attached and not move. However, a pathological condition can also be observed when the rectum extends beyond the anus.

This disease in medicine is characterized as rectal prolapse. When the intestine prolapses, the lower part of the rectum is stretched and falls out of the anus. As a result, patients may experience gas and fecal incontinence. The problem of bowel prolapse can be faced by people of all ages, including children. The pathological segment corresponds in length to scales from one to twenty centimeters.

Prolapse of the rectum can be internal (hidden) and external. The difference lies in the fact that with internal prolapse, the rectum has already lost its position, but it has not yet fallen out.

Rectal prolapse can occur in a hernial form, meaning that the anterior wall of the organ is displaced due to weakened pelvic muscles and high pressure in the abdominal cavity; as well as the invagination form, which is possible when a segment of the sigmoid or rectum is pressed inside the anus mucosa.

The problem of rectal prolapse has been studied for more than a hundred years, and during this time several classifications of this disease have been proposed. Among them, the most popular are the following fallout classifications:

• The first degree suggests that the rectum protrudes only during defecation.
• The second degree is characterized by prolapse of the rectum, not only during defecation, but during exercise.
• The third degree is associated with prolapse of the rectum when walking and even when the person is in an upright position.

Causes of rectal prolapse

The main cause of rectal prolapse is intestinal intussusception. However, the disease provocateurs include anatomical or genetic features of the human body, expressed in weak muscles located in the pelvic floor and unable to cope with the load during defecation, and therefore gradually stretch; abnormal location of the uterus relative to the rectum; elongated mesentery – a ligament connecting the posterior and anterior walls of the peritoneum; elongated sigmoid colon; anomalies in the structure of the sacrum and coccyx; weak anal sphincter.

These causes are associated with congenital pathologies, but may also have a traumatic nature. The muscles of the pelvic floor and anal sphincter can weaken in a woman after a natural birth. Due to surgery, injuries of the anterior abdominal wall, perineum, rectum or anus, the holding abilities of muscles and ligaments change.

How to treat rectal prolapse in adults

To eliminate rectal prolapse, conservative and surgical treatment is carried out. Patients are advised to follow a diet, perform a set of exercises to strengthen the muscles of the pelvic floor, anal sphincter and perineum in order to normalize the stool. In order for the disease not to progress, the patient completely excludes physical activity.

MEDICAL THERAPY

In the first stages of the disease, the use of conservative treatment is recommended, when the retraction of the rectum occurs independently. The goals of therapy are to reduce unpleasant symptoms; eliminate constipation and diarrhea; restore the tone of the anal sphincter and rectum.

The list of drugs is not numerous. In most cases, drugs are prescribed that can regulate stool. We are talking about laxative suppositories or oral preparations (tablets, powders for preparing drinks. If the patient experiences severe pain, it is necessary to start taking painkillers.

SURGICAL INTERVENTION

Surgical treatment is used at stages 3 and 4 of rectal prolapse, as well as if conservative therapy has been ineffective. In medicine, it is customary to talk about several methods that fix the rectum in a physiologically correct position. All methods are differentiated into several groups, the difference of which is related to the principle of influence on organs.

Consider the main methods of surgical treatment of rectal prolapse, presented by methods of narrowing the anus; operations of rectopexy or attachment of the distal rectum to the fixed parts of the small pelvis; colopexy – transperitoneal fixation of the distal sigmoid colon to the fixed formations of the pelvis or abdominal wall; operations aimed at strengthening the pelvic floor and perineum; partial or complete resection of the prolapsed intestine.

COMPLICATIONS

The most common form of complication of rectal prolapse is strangulation of the prolapsed portion of the rectum. If treatment was started late, there is a risk of developing necrosis of the strangulated tissues.

PREVENTION

Prevention suggests that, firstly, it is necessary to eliminate heavy physical exertion and other factors that develop these pathologies, and, secondly, to normalize the digestive tract.

THERE ARE CONTRAINDICATIONS. YOU NEED TO CONSULT WITH A SPECIALIST

The materials posted on this page are for informational purposes and are intended for educational purposes. Site visitors should not use them as medical advice. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your doctor!

Rectal prolapse – methods of treatment, stages of prolapsed nodes, symptoms and complications

Prices Doctors Our centers

Classification Symptoms Complications Diagnosis Treatment methods Prognosis Prevention

Rectal prolapse , or rectal prolapse is a pathological condition
which is accompanied by the release of the mucosa beyond the boundaries of the anal sphincter. All layers of the diastal layer fall out
segment of the large intestine. The protruding segment in this case ranges from 2 to 20 centimeters and even more.

Often this disease is diagnosed in men, they account for 70% of clinical cases. In 30% pathology
occurs in women. Prolapse is predominantly formed in people of working age from 20 to 50 years, however
often occurs in babies 3-4 years old due to the specifics of the anatomical and physiological characteristics of the child
organism.

Causes of weakening of muscles and ligaments, which leads to prolapse of rectal nodes:

• hereditary predisposition;
• incorrect anatomical structure of the pelvic bones, shape and rectum and sigmoid colon, intestinal wall;
• prolonged defecation disorders: diarrhoea, constipation;
• excessive straining during urination;
• parasitic intestinal infections;
• injuries of pelvic nerves and muscles;
• regular excessive physical activity, hard work, heavy lifting;
• heavy or multiple childbirth in women;
• diseases of the nervous system.

Classification

The official classification of human rectal prolapse is used by specialists when developing a therapeutic
scheme. It provides for the distribution of pathology into three stages:

• Stage 1 (compensated) – the intestine falls out only during defecation and returns on its own
  in a natural position;
• stage 2 (subcompensated) – prolapse occurs during bowel movements and at high
  physical exertion, accompanied by insufficiency of the anal sphincter;
• stage 3 (decompensated) – prolapse of the rectum is observed even when walking, coughing, sneezing,
  accompanied by incontinence of feces, gases, severe insufficiency of the sphincter.

Specialists also distinguish two types of rectal prolapse:

• Hernia – Douglas pouch and anterior wall of the rectum move down, with weak muscles
  pelvic floor and constant high intra-abdominal pressure lead to prolapse of the intestine into the anal canal. Through
  time, all the walls are involved in the pathological process, and the sagging increases.
• Invaginated or internal prolapse – part of the rectum or sigmoid colon is embedded in the lumen
  other part of the intestine. In this case, the organ does not go outside, and the main symptom of pathology is regular
  strong pain attacks.

Symptoms

Symptoms of pathology occur both gradually and suddenly. An unexpected start is associated with sharp and intense
loads, stress. After such an episode, the rectum falls out, and the person feels sharp pains in the abdomen, up to
to pain shock.

More often, however, rectal prolapse develops gradually. As the pathology progresses, it becomes more
pronounced and signs of loss:

• sensation of a foreign body in the anus;
• abdominal pain that worsens with walking, exertion, defecation;
• incontinence, inability to hold back gases, feces;
• frequent false urge to defecate;
• sensation of incomplete bowel movements;
• frequent urination;
• secretion of mucus, blood from the anus;
• the formation of a solitary ulcer, mucosal edema (with internal prolapse).

Untreated complications

The most dangerous complication that occurs when prolapse is ignored is the infringement of the prolapsed segment of the intestine.
Infringement appears with untimely intervention or when you try to set the prolapse on your own.
Accompanied by edema, increasing ischemia, impaired blood supply. If you do not seek help in time,
the outer portion of the tissues will be affected by necrosis (tissue necrosis).

Another complication that pathology leads to is solitary ulcers. Such wounds cause over time
bleeding leading to perforation.

In advanced stages of internal prolapse, acute intestinal obstruction and peritonitis often occur. These are dangerous
conditions that pose a threat to human life.

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Diagnostics

A proctologist can diagnose rectal prolapse and the degree of prolapse of the intestine even without examination and analysis
symptoms. The prolapsed part of the organ has a cone-shaped, cylindrical or spherical shape, painted in
bright red or bluish tint. The mucous membrane is markedly swollen and bleeds on contact. On
in the early stages, you can set the intestine and restore the normal state of the tissues. If at the time of examination the prolapse is not
observed, the patient is offered to strain to provoke a prolapse.

During a digital examination, the doctor determines the tone of the sphincter, differentiates the disease from hemorrhoids and anal
polyps. After that, for an accurate diagnosis, identification of complications and the exact stage of the disease,
instrumental diagnostics, which includes:

• colonoscopy – to identify the causes of the pathology;
• barium enema – to detect functional changes in the colon;
• defectography (proctography) – to determine the degree of prolapse;
• anorectal manometry – to assess muscle function;
• endoscopic examination (sigmoidoscopy) – to detect intussusception, the presence of ulcers;
• endoscopic biopsy with tissue examination – is prescribed if a solitary ulcer is detected to exclude
  oncology of the rectum;
• gynecological examination – for women.

Methods of treatment of rectal prolapse

Conservative approaches are used only in the earliest stages of the disease. The main purpose of such events is
normalize stool and eliminate increased intra-abdominal pressure. Clinical recommendations include:

• high fiber diet;
• drinking plenty of water;
• laxatives;
• drugs to increase peristalsis;
• neurostimulation, which helps to regain control over the muscles in case of impaired innervation.

Surgical methods of treatment bring results in the later stages of the development of prolapse, as well as in cases where
when conservative therapy fails. There are many operations that help get rid of
pathology. They include:

• excision of the prolapsed section of the rectum;
• intestinal fixation;
• anal canal, pelvic floor plasty;
• colon resection;
• combined methods.

Resection of the prolapsed section is more often done predominantly by surgery
Delorme. The surgeon removes the mucous membrane and forms a new muscle layer in the anal canal area. Operation
has a low invasiveness and is suitable even for older patients with serious chronic pathologies.
Less commonly, resection of the prolapsed lobe is done by patchwork cutting according to Nelaton or circular removal according to Mikulich.

Among fixation methods, rectopexy is considered the most effective –
an operation in which the pelvic section of the intestine is attached to the walls of the pelvis, thus restoring the correct
organ anatomy. The operation is performed on patients under 50-55 years of age. In 97% of cases, organ prolapse is eliminated.

Anal plastic surgery helps narrow the anus with surgical sutures and wires,
synthetic materials. However, this group of methods has a high risk of recurrence, so it is rarely used.

Resection of the distal colon is necessary if the patient has a solitary ulcer or necrosis. Often
such an operation is combined with fixing operations.

SM-Clinic surgeons have experience in performing various types of prolapse surgery. Our clinicians in
are fluent in modern surgical techniques and successfully help patients get rid of pathological
bowel prolapse.

Forecast

Surgical treatment brings a positive result without recurrence in 80% of cases. In 70-75% of patients, as a result
treatment restores the evacuation capacity of the intestine. At the same time, 25-30% of patients develop disorders
transitory function.

Moreover, the earlier the patient seeks help, the more favorable the prognosis will be. Unfortunately, patients often go to
doctor only in the later stages of the development of pathology, when prolapse is already obvious, bowel functions are impaired, and in
tissues began to undergo irreversible changes. In this case, the risk of developing life-threatening complications increases in
times.

Prophylaxis

To prevent the disease, as well as to prevent relapse, doctors recommend eliminating factors that increase
intra-abdominal pressure and cause weakness of the pelvic floor muscles:

• avoid injuries in the pelvis, sacrum;
• physical activity, stress;
• treat constipation, flatulence, diarrhea;
• do not start urolithiasis, prostate adenoma;
• to prevent hacking painful cough.

Pathology develops as a result of a combination of several factors, so for prevention it is necessary to minimize all
risks.

Specialists in this field 21 doctors

Leading doctors 6 doctors

Marina Borisovna Petrushina

Surgeon, proctologist

Work experience: 42 years

Udarnikov, 19

m. Ladozhskaya

Make an appointment

Aramyan David Surenovich

Surgeon, coloproctologist, oncologist, mammologist

Work experience: 13 years Reception

Kolosovsky Yaroslav Viktorovich

Surgeon, mammologist, oncologist

Work experience: 17 years

Dybenko, 13k4

m. make an appointment

Karapetyan Zaven Surenovich

Coloproctologist, surgeon and phlebologist

Work experience: 15 years

Dunaisky, 47

Dunayskaya metro station

Marshala Zakharov, 20

Leninskiy avenue metro station

Make an appointment 90 003 Andrey Shishkin

Surgeon, phlebologist, proctologist. Candidate of Medical Sciences

Work experience: 13 years

Dunaysky, 47

Dunayskaya metro station

Make an appointment

Maslennikov Dmitry Yurievich

Surgeon, proctologist, mammologist

Work experience: 16 years

Udarnikov, 19

Ladozhskaya metro station

Dybenko, 13k4

Dybenko street metro

Make an appointment

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+15 doctors

Other doctors 15 doctors

Ardashov Pavel Sergeevich

Coloproctologist-surgeon

Work experience: 9 years

Udarnikov, 19

persons Dybenko

Make an appointment

Bulkina Maria Sergeevna

Coloproctologist, surgeon

Work experience: 11 years

Dunaysky, 47

Dunayskaya metro station

Vyborgskoe shosse, 17

Prosveshcheniya metro station 9000 3

Make an appointment

Grinevich Vladimir Stanislavovich

Surgeon, oncologist, mammologist, coloproctologist

Work experience: 27 years

Vyborgskoe shosse, 17

m.
Klyuev Andrey

Operating proctologist

Work experience: 16 years

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment

Nekrasov Roman Aleksandrovich

Coloproctologist and surgeon

Work experience: 8 years

Udarnikov, 19

Ladozhskaya metro station

Marshala Zakharov, 20

Leninsky pr. -t

Make an appointment

Petrova Vitalina Vasilievna

Operative proctologist

Work experience: 12 years

Vyborgskoe shosse, 17

Prospect Prosveshcheniya metro station

Make an appointment

Senko Vladimir Vladimirovich

Head of the Center for Surgery and Oncology

Work experience: 23 years Leninsky Prospekt

Vyborgskoe shosse, 170003

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Sinyagina (Nazarova) Maria Andreevna

Surgeon, proctologist

Work experience: 8 years

Marshala Zakharova, 20

60
Sokolova Anna Sergeevna

Coloproctologist, surgeon. Candidate of Medical Sciences.

Work experience: 13 years

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment

Sol Anton Aleksandrovich

Work experience: 15 years

Vyborgskoe shosse, 17

Prospekt Prosveshcheniya metro station

Make an appointment

Fomenko Nikolai Aleksandrovich

Surgeon, proctologist, oncologist

Work experience: 15 years

Marshal Zakharova, 20

m. Leninsky pr-t

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Khangireev Alexander Bakhytovich

Surgeon, oncologist, coloproctologist

Work experience: 13 years

Udarnikov, 19

Ladozhskaya metro station

Dunaiskiy, 47

Dunaiskaya metro station

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Khokhlov Sergey Viktorovich

Surgeon, oncologist, coloproctologist

Work experience: 28 years old

Vyborg highway, 17

m. Prospekt Prospect

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Chuprina Susanna Vladimirovna

Coloproctologist of the highest category

Work experience: 22 years

Udarnikov, 19

Ladozhskaya metro station

Make an appointment

Yalda Ksenia Davidovna

Coloproctologist

Work experience: 11 years

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment

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