Mucosa prolapse. Rectal Prolapse: Causes, Symptoms, and Treatment Options

12.09.202308.07.2023 by alexxlab

What are the main causes of rectal prolapse. How is rectal prolapse diagnosed and treated. What are the different types of rectal prolapse. What complications can arise from rectal prolapse. How does rectal prolapse affect different age groups.

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Understanding Rectal Prolapse: An Overview

Rectal prolapse is a condition where the rectum, the final portion of the large intestine, turns inside out and protrudes through the anus. This medical issue affects people of all ages, but it’s particularly common in women over 65 and young children under 3. While the exact cause remains unknown, several risk factors have been identified.

The rectum, measuring approximately 20 cm in length, serves as a temporary storage area for bowel movements. When prolapse occurs, manual intervention may be necessary to push the rectum back into place if left untreated. Interestingly, women are six times more likely to experience rectal prolapse compared to men.

Types of Rectal Prolapse: From Internal to External

Rectal prolapse is categorized into three main types based on severity:

Internal prolapse: The rectum has prolapsed but doesn’t extend beyond the anus
Mucosal prolapse: Only the inner lining of the rectum protrudes through the anus
External prolapse: The entire thickness of the rectum extends outside the anus

Understanding these distinctions is crucial for proper diagnosis and treatment. Internal prolapse, also known as incomplete prolapse, can be challenging to detect and may require specialized diagnostic techniques.

Progression of Rectal Prolapse

In the early stages of rectal prolapse, a portion of the rectum may slip out during bowel movements but retract on its own. As the condition progresses, manual intervention becomes necessary to reposition the prolapsed tissue.

Recognizing the Symptoms of Rectal Prolapse

The symptoms of rectal prolapse can vary depending on the severity of the condition. Common signs include:

Pain and discomfort in the lower abdomen
Blood and mucus discharge from the anus
Sensation 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 liquid stool, particularly following defecation
Fecal incontinence or reduced bowel control

Are these symptoms always indicative of rectal prolapse. While these signs can strongly suggest rectal prolapse, it’s important to note that some symptoms may overlap with other gastrointestinal conditions. A proper medical evaluation is essential for an accurate diagnosis.

Unraveling the Causes and Risk Factors of Rectal Prolapse

Although the precise cause of rectal prolapse remains elusive, researchers have identified several risk factors that may contribute to its development:

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

Can lifestyle changes help prevent rectal prolapse. Indeed, adopting healthy habits can significantly reduce the risk of developing rectal prolapse. Maintaining a diet rich in fiber, staying hydrated, and engaging in regular physical activity can help prevent chronic constipation, a major risk factor for this condition.

The Role of Pelvic Floor Health

Pelvic floor muscles play a crucial role in supporting the rectum and other pelvic organs. Weakening of these muscles, often due to aging, childbirth, or chronic straining, can contribute to the development of rectal prolapse. Pelvic floor exercises, also known as Kegel exercises, can help strengthen these muscles and potentially reduce the risk of prolapse.

Diagnosing Rectal Prolapse: From Physical Exams to Advanced Imaging

Diagnosing rectal prolapse typically begins with a physical examination. In cases where the prolapse retracts on its own after bowel movements, the patient may need to strain during the examination to demonstrate the condition. For suspected internal prolapse, additional diagnostic tests may be necessary:

Ultrasound imaging
Specialized X-rays
Anorectal manometry (measurement of anal sphincter muscle activity)

If rectal bleeding is present, further tests may be conducted to rule out other conditions such as bowel cancer. In children with rectal prolapse, testing for cystic fibrosis is crucial, as approximately 11% of affected children have this genetic disorder.

How accurate are these diagnostic methods. While physical examination remains the primary diagnostic tool, advanced imaging techniques provide high accuracy in detecting and characterizing rectal prolapse, especially in cases of internal prolapse that may not be visible externally.

Treatment Approaches for Rectal Prolapse: From Conservative to Surgical

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

Diet and lifestyle changes to address chronic constipation
Application of surgical rubber bands to secure mucosal prolapse
Surgical intervention

For young children, dietary modifications and lifestyle changes are often sufficient to resolve rectal prolapse without the need for surgery. This approach typically involves increasing intake of fruits, vegetables, and whole grains, ensuring adequate hydration, and promoting regular physical activity.

Surgical Interventions for Rectal Prolapse

When conservative measures are insufficient, surgery may be necessary to secure the rectum in place. Surgical approaches can be broadly categorized into two types:

Abdominal surgery: Performed through an incision in the abdomen
Perineal surgery: Conducted through the anus

The choice between these approaches depends on various factors, including the patient’s overall health, the extent of the prolapse, and the surgeon’s expertise. Both methods aim to restore the normal position of the rectum and improve bowel function.

What are the success rates of surgical treatments for rectal prolapse. Success rates for rectal prolapse surgery are generally high, with many patients experiencing significant improvement in symptoms and quality of life. However, the exact success rate can vary depending on the specific surgical technique used and individual patient factors.

Potential Complications of Rectal Prolapse: Understanding the Risks

While rectal prolapse itself can be distressing, it may also lead to various complications if left untreated:

Damage to the rectum, including ulceration and bleeding
Incarceration: Inability to manually reposition the prolapsed rectum
Strangulation: Reduced blood supply to the prolapsed tissue
Gangrene: Death and decay of the strangulated rectal segment

These complications underscore the importance of timely diagnosis and appropriate treatment. Prompt medical attention can help prevent these serious outcomes and improve overall prognosis.

Long-term Implications of Rectal Prolapse

Beyond the immediate complications, rectal prolapse can have significant long-term impacts on a person’s quality of life. Chronic pain, fecal incontinence, and social embarrassment are common issues faced by those with untreated or recurrent rectal prolapse. These factors can lead to social isolation, depression, and a decrease in overall well-being.

How can patients cope with the psychological impact of rectal prolapse. Support groups, counseling, and open communication with healthcare providers can be invaluable in managing the emotional aspects of living with rectal prolapse. Many patients find that addressing both the physical and psychological aspects of the condition leads to better overall outcomes.

Rectal Prolapse in Different Age Groups: From Infants to Elderly

Rectal prolapse affects individuals across the lifespan, but its presentation and management can vary significantly between age groups:

Rectal Prolapse in Children

In children, particularly those under three years of age, rectal prolapse is relatively common. The good news is that in most cases, it resolves spontaneously without the need for surgical intervention. Dietary modifications to prevent constipation are often sufficient to manage the condition in young patients.

For children with persistent rectal prolapse, it’s crucial to investigate underlying conditions such as cystic fibrosis. The association between rectal prolapse and cystic fibrosis in children highlights the importance of comprehensive evaluation in pediatric cases.

Rectal Prolapse in Adults

In adults, particularly women over 65, rectal prolapse tends to be a more chronic condition requiring more intensive management. The weakening of pelvic floor muscles due to aging, childbirth, and other factors contributes to the higher prevalence in this demographic.

Treatment for adults often involves a combination of conservative measures and, in many cases, surgical intervention. The choice of treatment depends on the severity of the prolapse, overall health status, and individual patient preferences.

Why is rectal prolapse more common in women than in men. The higher incidence in women is likely due to several factors, including the effects of childbirth on pelvic floor muscles, hormonal changes associated with menopause, and anatomical differences in the pelvic region between males and females.

Prevention and Management of Rectal Prolapse: Lifestyle Strategies

While not all cases of rectal prolapse can be prevented, certain lifestyle modifications can reduce the risk and help manage existing conditions:

Maintaining a high-fiber diet to prevent constipation
Staying adequately hydrated
Engaging in regular physical activity
Practicing proper toilet habits, avoiding straining during bowel movements
Performing pelvic floor exercises to strengthen supporting muscles
Managing chronic cough or other conditions that increase abdominal pressure

For individuals with rectal prolapse, these strategies can complement medical treatments and help prevent recurrence after surgical intervention.

The Role of Diet in Managing Rectal Prolapse

Diet plays a crucial role in both the prevention and management of rectal prolapse, particularly in addressing chronic constipation. A diet rich in fiber helps promote regular bowel movements and reduces the need for straining, which is a significant risk factor for rectal prolapse.

What are some fiber-rich foods that can help prevent constipation. Excellent sources of dietary fiber include:

Whole grains (e.g., oats, brown rice, quinoa)
Legumes (e.g., lentils, beans, chickpeas)
Fruits (e.g., apples, pears, berries)
Vegetables (e.g., broccoli, carrots, spinach)
Nuts and seeds

Incorporating these foods into the daily diet, along with adequate fluid intake, can significantly improve bowel regularity and reduce the risk of rectal prolapse.

Emerging Treatments and Research in Rectal Prolapse

The field of rectal prolapse treatment is continuously evolving, with researchers exploring new approaches to improve outcomes and reduce recurrence rates. Some areas of ongoing research and emerging treatments include:

Minimally invasive surgical techniques
Robotic-assisted surgery for improved precision
Bioengineered tissue reinforcement materials
Novel pharmaceutical interventions to strengthen pelvic floor muscles
Advanced imaging techniques for early detection of internal prolapse

These advancements hold promise for more effective and less invasive treatments in the future, potentially improving quality of life for those affected by rectal prolapse.

The Future of Rectal Prolapse Management

As our understanding of the underlying mechanisms of rectal prolapse deepens, new avenues for prevention and treatment continue to emerge. Personalized medicine approaches, taking into account individual genetic, anatomical, and lifestyle factors, may lead to more tailored and effective interventions.

How might genetic research contribute to rectal prolapse treatment. Genetic studies could potentially identify individuals at higher risk for developing rectal prolapse, allowing for earlier intervention and prevention strategies. Additionally, understanding the genetic basis of pelvic floor disorders may lead to the development of targeted therapies in the future.

In conclusion, rectal prolapse is a complex condition that affects individuals across the lifespan. While it can be distressing and potentially lead to serious complications, a range of treatment options is available. From conservative measures to surgical interventions, management strategies can be tailored to individual needs. Ongoing research continues to shed light on this condition, promising improved outcomes for those affected by rectal prolapse in the years to come.

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.

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.

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

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

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

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

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:

Give feedback about this page

Was this page helpful?

More information

Content disclaimer

Reviewed on: 30-09-2014

Rectal prolapse – methods of treatment, stages of prolapse, 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, exercise, defecation;
incontinence, inability to hold back gases, stools;
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).

Complications in the absence of treatment

The most dangerous complication that occurs when ignoring prolapse 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 bowel prolapse 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 of 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;
bowel fixation;
plastic surgery of the anal canal, pelvic floor;
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 agonizing 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

Petrushina Marina Borisovna

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

Yaroslav Viktorovich Kolosovsky

Surgeon, mammologist, oncologist

Work experience: 17 years

Dybenko, 13k4

m. Dybenko Street

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

Show more
+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

Operating proctologist

Work experience: 12 years

Vyborgskoe shosse, 17

Prospekt 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, 17

m Prospect Prosveshcheniya

Make an appointment

Sinyagina (Nazarova) Maria Andreevna

Surgeon, proctologist

Work experience: 8 years

Marshala Zakharova, 20

06
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

Vyborgskoye shosse, 17

metro Prosveshcheniya

Make an appointment

Fomenko Nikolai Aleksandrovich

Surgeon, proctologist, oncologist

Work experience: 15 years

Marshal Zakharova, 20

m. Leninsky pr-t

Khangireev Alexander Bakhytovich

Surgeon, oncologist, coloproctologist

Work experience: 13 years

Udarnikov, 19

Ladozhskaya metro station

Dunaiskiy, 47

Dunaiskaya metro station

Make an appointment

Khokhlov Sergey Viktorovich

Surgeon, oncologist, coloproctologist

Work experience: 28 years old

Vyborg highway, 17

m. Prospekt Prospect

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

Hide the list 90 003

Our offices in St.

Petersburg

6 branches

Center for Surgery Dunayskaya metro station

47 Dunaisky prospect

Dunaiskaya metro station

daily from 09:00 to 22:00

Surgery Center Ladozhskaya metro station

Udarnikov Avenue, 19/1

Ladozhskaya metro station

daily from 09:00 to 22:00

Center for Surgery Metro station “Leninsky Prospekt”

st. Marshal Zakharov, d.
daily from 09:00 to 22:00

Center for Surgery Prospekt Prosveshcheniya metro station

Vyborgskoe shosse, 17 building 1

Prospect Prosveshcheniya metro station

daily from 09:00 to 22:00

Surgery Center Kupchino metro station

Malaya Balkanskaya street, 23

Kupchino metro station

daily from 09:00 to 22:00

Center for Surgery Dybenko Street

Dybenko Street, 13k4

m. Dybenko street

daily from 09:00 to 22:00

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

Prices Doctors Our centers

Classification Symptoms Complications Diagnosis Treatment methods Prognosis Prevention

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

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, exercise, defecation;
incontinence, inability to hold back gases, stools;
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).

Complications in the absence of treatment

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.

Promotion! Free consultation with a surgeon about surgery

Take advantage of this unique opportunity and get a free consultation about elective surgery.

Diagnostics

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

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

excision of the prolapsed section of the rectum;
bowel fixation;
plastic surgery of the anal canal, pelvic floor;
colon resection;
combined methods.

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.

Forecast

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 agonizing 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

Petrushina Marina Borisovna

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

Yaroslav Viktorovich Kolosovsky

Surgeon, mammologist, oncologist

Work experience: 17 years

Dybenko, 13k4

m. Dybenko Street

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

Show more
+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

Operating proctologist

Work experience: 12 years

Vyborgskoe shosse, 17

Prospekt 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, 17

m Prospect Prosveshcheniya

Make an appointment

Sinyagina (Nazarova) Maria Andreevna

Surgeon, proctologist

Work experience: 8 years

Marshala Zakharova, 20

06
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

Vyborgskoye shosse, 17

metro Prosveshcheniya

Make an appointment

Fomenko Nikolai Aleksandrovich

Surgeon, proctologist, oncologist

Work experience: 15 years

Marshal Zakharova, 20

m. Leninsky pr-t

Khangireev Alexander Bakhytovich

Surgeon, oncologist, coloproctologist

Work experience: 13 years

Udarnikov, 19

Ladozhskaya metro station

Dunaiskiy, 47

Dunaiskaya metro station

Make an appointment

Khokhlov Sergey Viktorovich

Surgeon, oncologist, coloproctologist

Work experience: 28 years old

Vyborg highway, 17

m. Prospekt Prospect

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

Hide the list 90 003