What is rectal prolapse? What causes it? What are the symptoms of rectal prolapse? How is rectal prolapse diagnosed and treated?

What is Rectal Prolapse?

Rectal prolapse occurs when part or all of the wall of the rectum slides out of place, sometimes sticking out of the anus. There are three types of rectal prolapse:

1. Partial prolapse (mucosal prolapse): The lining (mucous membrane) of the rectum slides out of place and usually sticks out of the anus. This can happen when you strain to have a bowel movement.
2. Complete prolapse: The entire wall of the rectum slides out of place and usually sticks out of the anus. At first, this may occur only during bowel movements, but eventually, it may occur when you stand or walk.
3. Internal prolapse (intussusception): One part of the wall of the large intestine (colon) or rectum may slide into or over another part, like the folding parts of a toy telescope. The rectum does not stick out of the anus.

What Causes Rectal Prolapse?

Several factors can increase the risk of developing rectal prolapse:

Causes in Children

• Cystic fibrosis
• Previous surgery on the anus as an infant
• Malnutrition
• Developmental problems
• Straining during bowel movements
• Infections

Causes in Adults

• Straining during bowel movements due to constipation
• Tissue damage caused by surgery or childbirth
• Weakening of pelvic floor muscles with age

What are the Symptoms of Rectal Prolapse?

The first symptoms of rectal prolapse may include:

• Fecal incontinence (leakage of stool from the anus)
• Leakage of mucus or blood from the anus (wet anus)

Other symptoms of rectal prolapse include:

• A feeling of having full bowels and an urgent need to have a bowel movement
• Passage of many very small stools
• The feeling of not being able to empty the bowels completely
• Anal pain, itching, irritation, and bleeding
• Bright red tissue that sticks out of the anus

How is Rectal Prolapse Diagnosed?

To diagnose rectal prolapse, your doctor will:

• Ask about your symptoms and medical history
• Perform a physical examination, including checking the rectum for loose tissue and the strength of the anal sphincter
• Order tests such as a sigmoidoscopy, colonoscopy, or barium enema to rule out other conditions
• In some cases, a child may need a sweat test to check for cystic fibrosis if the cause is not clear

How is Rectal Prolapse Treated?

The treatment for rectal prolapse depends on the type and severity of the condition:

Treatment for Children

In many cases, rectal prolapse in children goes away on its own. However, if the prolapse doesn’t go away or is caused by another condition, the child may need additional treatment, such as:

• Pushing the prolapse back into place
• Avoiding straining during bowel movements by using a potty-training toilet
• Injections of medicine into the rectum
• Treatment for the underlying condition (e.g., cystic fibrosis)

Treatment for Adults

Home treatment for adults may help treat the prolapse and may be tried before other types of treatments:

• Pushing the prolapse back into place (if your doctor says it’s okay)
• Avoiding constipation by drinking plenty of water and eating high-fiber foods
• Doing Kegel exercises to strengthen the pelvic floor muscles
• Avoiding straining during bowel movements and using stool softeners if needed

If home treatment is not effective, your doctor may recommend other treatments, such as surgery, to help correct the prolapse.

Preventing Rectal Prolapse

To help prevent rectal prolapse, it’s important to maintain good bowel habits and avoid straining during bowel movements. This includes:

• Drinking plenty of water
• Eating a high-fiber diet
• Using the restroom regularly and avoiding holding in bowel movements
• Performing Kegel exercises to strengthen the pelvic floor muscles

If you or your child is experiencing symptoms of rectal prolapse, it’s important to see a healthcare provider for proper diagnosis and treatment. Timely intervention can help prevent the condition from worsening and reduce the risk of complications.

Rectal Prolapse | HealthLink BC

Topic Contents

• Condition Basics
• Related Information
• Credits

Condition Basics

What is rectal prolapse?

Rectal prolapse occurs when part or all of the wall of the rectum slides out of place, sometimes sticking out of the anus.

There are three types of rectal prolapse.

Partial prolapse (mucosal prolapse).

The lining (mucous membrane) of the rectum slides out of place and usually sticks out of the anus. This can happen when you strain to have a bowel movement. Partial prolapse is most common in children younger than 2 years.

Complete prolapse.

The entire wall of the rectum slides out of place and usually sticks out of the anus. At first, this may occur only during bowel movements. Eventually, it may occur when you stand or walk. And in some cases, the prolapsed tissue may remain outside your body all the time.

Internal prolapse (intussusception).

One part of the wall of the large intestine (colon) or rectum may slide into or over another part, like the folding parts of a toy telescope. The rectum does not stick out of the anus. Intussusception is most common in children and rarely affects adults. In children, the cause is usually not known. In adults, it is usually related to another intestinal problem, such as a growth of tissue in the wall of the intestines (such as a polyp or tumour).

In severe cases of rectal prolapse, a section of the large intestine drops from its normal position as the tissues that hold it in place stretch. Typically there is a sharp bend where the rectum begins. With rectal prolapse, this bend and other curves in the rectum may straighten, making it difficult to keep stool from leaking out (fecal incontinence).

Rectal prolapse is most common in children and older adults, especially women.

What causes it?

Many things increase the chance of developing rectal prolapse. Risk factors for children include:

• Cystic fibrosis. A child who has rectal prolapse with no obvious cause may need to be tested for cystic fibrosis.
• Having had surgery on the anus as an infant.
• Malnutrition.
• Deformities or physical development problems.
• Straining during bowel movements.
• Infections.

Risk factors for adults include:

• Straining during bowel movements because of constipation.
• Tissue damage caused by surgery or childbirth.
• Weakness of pelvic floor muscles that occurs naturally with age.

What are the symptoms?

The first symptoms of rectal prolapse may be:

• Leakage of stool from the anus (fecal incontinence).
• Leakage of mucus or blood from the anus (wet anus).

Other symptoms of rectal prolapse include:

• A feeling of having full bowels and an urgent need to have a bowel movement.
• Passage of many very small stools.
• The feeling of not being able to empty the bowels completely.
• Anal pain, itching, irritation, and bleeding.
• Bright red tissue that sticks out of the anus.

See a doctor if you or your child has symptoms of rectal prolapse. If it is not treated, you may have more problems. For example, the leaking stool could get worse, or the rectum could be damaged.

How is it diagnosed?

Your doctor will diagnose rectal prolapse by asking you questions about your symptoms and past medical problems and surgeries. He or she will also do a physical examination, which includes checking the rectum for loose tissue and to find out how strongly the anal sphincter contracts.

You may need tests to rule out other conditions. For example, you may need a sigmoidoscopy, a colonoscopy, or a barium enema to look for tumours, sores (ulcers), or abnormally narrow areas in the large intestine. Or a child may need a sweat test to check for cystic fibrosis if prolapse has occurred more than once or the cause is not clear.

How is rectal prolapse treated?

Prolapse in children tends to go away on its own. You can help keep the prolapse from coming back. If you can, push the prolapse into place as soon as it occurs. You can also have your child use a potty-training toilet so that he or she does not strain while having a bowel movement.

Sometimes children need treatment. For example, if the prolapse doesn’t go away on its own, an injection of medicine into the rectum may help. If the prolapse was caused by another condition, the child may need treatment for that condition.

Home treatment for adults may help treat the prolapse and may be tried before other types of treatments.

• If your doctor says it’s okay, you can push the prolapse into place.
• Avoid constipation. Drink plenty of water, and eat fruits, vegetables, and other foods that contain fibre. Changes in diet often are enough to improve or reverse a prolapse of the lining of the rectum (partial prolapse).
• Do Kegel exercises to help strengthen the muscles of the pelvic area.
• Don’t strain while having a bowel movement. Use a stool softener if you need to.

People who have a complete prolapse or who have a partial prolapse that doesn’t improve with a change in diet will need surgery. Surgery involves attaching the rectum to the muscles of the pelvic floor or the lower end of the spine (sacrum). Or surgery might involve removing a section of the large intestine that is no longer supported by the surrounding tissue. Both procedures may be done in the same surgery.

Credits

1. Rectal Prolapse
2. Types of Rectal Prolapse
3. Intussusception
4. Large Intestine

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Rectal Prolapse | Gastroenterology

Rectal prolapse is when the lowest part of the large intestine, called the rectum [REK-tum] slips out of the anus. With this condition, the rectum comes out of the anus inside-out.

Rectal prolapse can make it difficult to hold your bowel movements. This can be uncomfortable and embarrassing, but most of the time it does not turn into a major medical situation.

In some cases, rectal prolapse can be treated with laxatives or stool softeners, but most of the time it needs to be fixed with surgery.

In most cases, the onset of a rectal prolapse happens over time. In the early stages, the prolapse will fall out as a bowel movement is passed and return to its proper place once the bowel movement is complete. Over time, the prolapse may not return to place on its own, and the patient may have to push it back into place. As the prolapse persists, the rectal mucus may become thicker and bleed a lot. Rarely, the prolapse can become stuck outside the anus. If this happens, surgery is most likely needed to fix it.

Rectal prolapse is not very common. It affects mostly adult (over age 50) women. Although very rare, it still may happen in younger people. If it is happening in someone younger, or a child, they should see a doctor. In some cases, if rectal prolapse is found in younger people, it may also appear with other conditions, such as autism, or psychiatric problems that may need treatment. 

Most of the time, rectal prolapse is self-diagnosable. Rectal prolapse can make it difficult to hold your bowels, which can make it feel as though the stools are leaking out of the anus. It can be especially difficult to hold your stools if you are having gas.

Other symptoms may include:

• Constipation
• Leaky stools
• Anal itchiness
• Discharge from the anus
• A bumpy anus
• A mass protruding from the anus

In most cases of rectal prolapse, it may be good to see a doctor if your stools become too embarrassing or difficult to hold. Your doctor can help you create a treatment plan.

Although doctors aren’t sure what exactly causes a rectal prolapse, there are some things that are linked to this condition. Some of these factors include:

• Chronic constipation
• In women, giving birth by vaginal delivery, especially more than once

Your doctor may perform a physical exam to help figure out how severe the rectal prolapse is, and also help decide on a treatment plan. Your doctor may also order a colonoscopy [COL-uhn-AHS-kuh-PEE] to rule out other, sometimes more severe, medical problems.

Treatments for rectal prolapse range from self-care to surgery. Most people that try self-treatment will likely need surgery later, and self-treatment usually just allows a patient to go longer without needing surgery.

Self-care treatments may include:

• Kegel exercises
• Dietary fiber
• Supportive clothing

There are also surgical options. The two most common are surgery from the perineum [PAIR-en-EE-um], or surgery from the abdomen.

Surgery from the perineum is where the rectum is surgically pressed back in from the bottom. Surgery from the abdomen is where the prolapse is pulled back in through the abdomen. Most of the time, both types of surgery are effective and result in a major increase in the patient’s quality of life. The choice of procedure depends on the other symptoms you may be having. Talk to your doctor about both options to figure out with one will be the best for you.

As doctors do not fully understand the cause of rectal prolapse, there are no proven ways to prevent it. Rectal prolapse is often linked to constipation, so it may be helpful to avoid this by eating a high fiber diet and exercising regularly. If you find you are having problems passing your stools, talk to your doctor to make sure it does not progress to rectal prolapse.

Rectal prolapse is when the lowest part of the large intestine, called the rectum [REK-tum] slips out of the anus. It can make it difficult to hold in your bowel movements. Most of the time, surgery is needed to fix it.

© 2018 Intermountain Healthcare. All rights reserved. The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns. 

Rectal prolapse – health articles

11/10/2022

Prolapse of the rectum

– a violation of the anatomical position of the rectum, in which there is a displacement of its distal part beyond the anal sphincter. Prolapse of the rectum may be accompanied by pain, incontinence of intestinal contents, mucous and bloody discharge, sensation of a foreign body in the anus, false urge to defecate. Diagnosis of rectal prolapse is based on examination data, rectal digital examination, sigmoidoscopy, irrigoscopy, manometry. Treatment of rectal prolapse is primarily surgical; is to perform resection and fixation of the rectum sphincter plasty.

Reasons

Among the possible causes of rectal prolapse, there are producing and predisposing causes.

The first group includes those factors that can cause protrusion of the rectal segment, for example, heavy physical exertion, in particular, a single overvoltage, as well as regular hard physical labor. This also includes: frequent constipation, in which a person is constantly forced to push hard; complications that arose during labor in women, in particular, ruptures of the perineum and traumatic injuries of the pelvic muscles; transferred surgical interventions in the intestinal area; traumatic injuries of the sacrum; the presence of ulcerative foci on the surface of the intestinal mucosa.

Predisposing factors that significantly increase the risk of developing the disease include: various anatomical defects in the structure of the pelvis and intestines, for example, the vertical position of the coccyx or lengthening of the rectum; diseases of the gastrointestinal tract and genitourinary system; passion for non-traditional types of sex associated with the risk of injury to the rectum; reduced tone of the anal sphincter, sprain – conditions that are characteristic mainly of the elderly; general dysfunction of the pelvic organs; neurological disorders affecting the spinal cord; hereditary predisposition.

Symptoms

The onset of the disease can be either gradual or acute. During an acute course, the rectum falls out at one moment. This mainly happens with strong straining, a sharp lifting of weights, and so on. Such phenomena are accompanied by unpleasant sensations in the perineal region and in the muscles of the anterior abdominal wall, as well as the occurrence of severe pain in the anus. As for the gradual course, it develops due to high intra-abdominal pressure – for example, with constant constipation. In such a situation, bowel prolapse is observed, which then becomes more and more pronounced, and ultimately there is a complete prolapse of the rectal ampulla (prolapse).

Diagnostics

For diagnosis, the doctor needs a detailed history of the disease and a thorough examination of the anorectal region. To determine rectal prolapse, the patient may be asked to strain while sitting on a toilet seat, thereby simulating the act of defecation (emptying the rectum). Sometimes rectal prolapse can be “hidden” or internal, in which case the diagnosis of the disease can be difficult. To determine the degree of rectal prolapse, a special x-ray examination is used – defecography. During this procedure, X-rays are taken during the simulation of the act of defecation. This helps the doctor determine the severity of anatomical and functional disorders, as well as the need and method of surgical treatment. Using anorectal manometry, it is also possible to assess the function of the muscles located around the intestine, and evaluate their participation in the act of defecation.

Treatment

Therapy of the initial forms of rectal prolapse most often involves the use of conservative methods. We note right away that almost all conservative methods, such as physiotherapy, pararectal injections of sclerosing drugs, stimulation of the sphincter muscles and the pelvic floor, do not provide a 100% guarantee of a complete cure for the patient. That is why almost all experts recommend surgical intervention in the fight against this pathology. Moreover, the sooner the patient is operated on, the more chances to avoid the development of certain complications.

Only children are an exception to the rule, since in childhood the operation can be delayed. With the development of this pathological condition in a child, he should first of all be taught to go to the toilet according to a certain regimen. Of course, such training will take a lot of time, but it is still possible to achieve the desired result. In addition, it is very important to feed the child with foods that contain a large amount of fiber. Equally important is the correct water toilet after defecation.

As for surgical interventions, today there are about fifty of them, and almost all of them are effective. Among the most used surgical interventions in the fight against rectal prolapse are:

– suturing of the rectum;
– resection of part of the large intestine;
– plastic surgery on the muscles of the pelvic floor and rectal canal;
– an operation that is aimed at a prolapsed fragment of the intestine;
– combination of different methods.

The choice of surgical method depends on the general condition of the patient, the severity of the disease, the age of the patient, etc. Modern technologies of surgical treatment make it possible to perform surgical interventions using laparoscopy, which significantly reduces the recovery period and reduces the risk of complications.

Rectal prolapse – prolapse of the rectum. Causes, symptoms, diagnosis and treatment

Rectal prolapse is an exit, prolapse of all layers of the rectal wall outside the anal ring, a sphincter. The length of the drop-down fragment can vary from 2 to 20 or more centimeters.

Rectal prolapse occurs in both children and adults. In adults, the disease occurs in men of working age engaged in heavy physical labor, but most often this pathology is diagnosed in women over 50 years of age with a history of several births.

Causes

The following factors increase the risk of developing this problem:

• Features of the structure of the pelvis, in particular the sacrum. It usually has a concave curve facing the inside of the pelvis, and the rectum is just in this concavity. If it is weakly expressed, as, for example, happens in children, the intestine seems to slip off, which leads to its prolapse.
• Dolichosigma – lengthening of the sigmoid colon and / or its mesentery.
• Weakening of the muscles of the pelvis and anal sphincter, which is most characteristic of older patients.

The following factors lead directly to bowel prolapse:

• Physical tension accompanied by an increase in pressure inside the abdominal cavity. Prolapse can occur even from a single excessive physical activity, but more often develops with constant physical exertion.
• Injuries of the pelvic area.
• The presence of neoplasms in the rectum, such as polyps or malignant tumors.
• Chronic diseases of the digestive system, accompanied by constipation and diarrhea.
• Diseases of the respiratory system, accompanied by chronic cough.
• In women, rectal prolapse can be provoked by pregnancy and childbirth.
• Anal sex.

Symptoms

Most often, rectal prolapse develops gradually. At first, prolapse is noted only during straining, after which the intestine is retracted on its own. In the second stage of the disease, self-reduction does not occur, you have to help yourself with your hands. And, finally, at the decompensated stage, prolapse is noted at the slightest physical exertion, the intestine falls out even just when taking a vertical position.

The following symptoms are noted:

• Pain. Develops due to tension of the mesentery. After repositioning the intestine, it subsides.
• Urge to defecate.
• Discharge from the anus of mucus and blood – occur due to injury to the intestinal mucosa.
• Gas incontinence.
• Encoprese – fecal incontinence.

As the prolapse increases, other internal organs are involved in the process, which is accompanied, for example, by frequent urination, prolapse of the overlying sections of the large intestine. A particular threat is the displacement of the loops of the small intestine, which can cause intestinal obstruction and necrosis of its wall.

Diagnostics

Diagnosis of rectal prolapse requires examination by a proctologist. During prolapse, the presence of a neoplasm of a bright red or cyanotic color is noted, which is caused by a violation of the blood supply to the intestinal wall. In the center of the formation there will be a slit-like or star-shaped hole. When the intestine is repositioned, ischemia disappears, blood circulation is restored, and the mucosa acquires a normal color.

Finger examination allows differential diagnosis between prolapse of the intestine and hemorrhoids or anal polyps. At the same time, the tone of the sphincter is assessed. A more detailed assessment of the condition of the pelvic floor muscles can be done using manometry.

Endoscopic examination methods will determine the causes of prolapse and exclude the presence of pathological formations (tumors, diverticula, dolichosigma, coprostasis, etc.). The functional features of the intestine will help evaluate radiological diagnostic methods, for example, the study of the passage of barium, defectography.

Treatment

Complete cure of rectal prolapse is possible only by surgery. More than 200 variants of operations have been developed that can be performed using different approaches, including laparoscopically, transanally, laparotomically, through the perineum. The choice of technique is determined by the age of the patient, his state of health, the causes of the disease and the degree of prolapse. The most commonly used posterior loop rectopexy, in which the rectum is sutured to the sacrum. In addition, the following techniques are used:

• Resection of the prolapsed segment of the intestine. Circular or patchwork clipping may be used.
• Pelvic floor plasty. For example, the technique of suturing levators and attaching them to the rectum is used. Rarely used surgical narrowing of the anal canal.
• Colon resection. Such interventions are used for dolichosigma or tumors.

It should be noted that these are very complex operations, and they are performed only on the basis of a specialized medical institution, for example, OKB No.