What are the symptoms of rectal prolapse? What causes rectal prolapse? How is rectal prolapse treated? Find the answers to these questions and more in this detailed article.

Defining Rectal Prolapse

Rectal prolapse is a condition in which the rectum, the last portion of the large intestine, turns inside out and protrudes through the anus. This can happen due to a variety of factors, including chronic constipation, weakened pelvic floor muscles, and the natural aging process.

Symptoms of Rectal Prolapse

The symptoms of rectal prolapse can vary in severity, but may include pain and discomfort in the lower abdomen, bleeding and mucus discharge from the anus, a feeling of incomplete bowel movements, difficulties passing stool, protrusion of the rectum through the anus, and in severe cases, fecal incontinence.

Types of Rectal Prolapse

Rectal prolapse is categorized into three main types:

1. Internal prolapse – the rectum has prolapsed, but not enough to slip through the anus
2. Mucosal prolapse – the inner lining of the rectum protrudes through the anus
3. External prolapse – the entire thickness of the rectum protrudes through the anus, also known as complete or full-thickness prolapse

Causes of Rectal Prolapse

The exact cause of rectal prolapse is unknown, but several risk factors have been identified, including:

• Chronic constipation and straining during bowel movements
• Weakened pelvic floor muscles and anal sphincter muscles
• Aging, as rectal prolapse is more common in people over 65
• Genetic predisposition, with some people having a family member with the same condition
• Parasitic infections, such as schistosomiasis (rare in Australia)
• Conditions that increase abdominal pressure, like benign prostatic hypertrophy or COPD
• Structural issues with the ligaments that anchor the rectum
• Congenital bowel problems, such as Hirschsprung’s disease or neuronal intestinal dysplasia
• Prior trauma to the lower back or disc disease in the lower back

Complications of Rectal Prolapse

If left untreated, rectal prolapse can lead to several complications, including:

• Damage to the rectum, such as ulceration and bleeding
• Incarceration, where the rectum cannot be manually pushed back in
• Strangulation of the rectum, reducing its blood supply
• Death and decay (gangrene) of the strangulated section of the rectum

Diagnosis of Rectal Prolapse

Rectal prolapse is typically diagnosed through a physical examination. In some cases, where the prolapse goes back inside on its own, the person may be asked to bear down during the examination to demonstrate the prolapse. Additional tests, such as ultrasound, x-rays, and anorectal manometry, may be used to confirm the diagnosis, especially in cases of suspected internal prolapse. It’s also important to test for conditions like cystic fibrosis, as about 11% of children with rectal prolapse have this condition.

Treatment for Rectal Prolapse

The treatment for rectal prolapse depends on several factors, including the age of the person, the severity of the prolapse, and the presence of any other pelvic abnormalities. Treatment options may include:

• Dietary and lifestyle changes to address chronic constipation, such as increasing fiber, fluid intake, and exercise
• Securing the structures in place with surgical rubber bands, in cases of mucosal prolapse
• Surgical interventions, either through the abdomen or the anus, to tether the rectum into place

In many cases, especially in young children, a diet that successfully treats constipation may be all that’s needed to resolve the rectal prolapse without the need for surgery.

Preventing Rectal Prolapse

While the exact cause of rectal prolapse is not fully understood, there are several steps that can be taken to help prevent it:

• Maintaining a healthy, high-fiber diet to prevent chronic constipation
• Engaging in regular exercise to strengthen the pelvic floor muscles
• Seeking prompt treatment for any conditions that may increase abdominal pressure, such as COPD or benign prostatic hypertrophy
• Addressing any underlying genetic or congenital factors that may contribute to rectal prolapse

By taking these preventive measures and seeking prompt medical attention if symptoms of rectal prolapse arise, individuals can help reduce the risk of this condition and its potentially serious complications.