Rectal Prolapse


Rectal Prolapse: Causes, Symptoms, Treatment

Rectal prolapse often used to mean complete rectal prolapse (external rectal prolapse), where the rectal walls have prolapsed to a degree where they protrude out the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on if the prolapsed section is visible externally, and if the full or only partial thickness of the rectal wall is involved.

Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may be mucous discharge (mucus coming from the anus), rectal bleeding, degrees of fecal incontinence and obstructed defecation symptoms.

Rectal prolapse is generally more common in elderly women, although it may occur at any age and in both sexes. It is very rarely life-threatening, but the symptoms can be debilitating if left untreated. ;Most external prolapse cases can be treated successfully, often with a surgical procedure. Internal prolapses are traditionally harder to treat and surgery may not be suitable for many patients.

Overall, rectal prolapse affects relatively few people (2.5 cases/100,000 people). This condition affects mostly adults, and women over 50 years of age are six times as likely as men to develop rectal prolapse. Most women with rectal prolapse are in their 60’s, while the few men who develop prolapse are much younger, averaging 40 years of age or less.  In these younger patients, there is higher rate of autism, developmental delay, and psychiatric problems requiring multiple medications.

Although an operation is not always needed, the definitive treatment of rectal prolapse requires surgery.

Types of rectal prolapse

There are three types of rectal prolapse:

  • Partial prolapse (also called 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 apolyp or tumor).

Signs and symptoms

Signs and symptoms include:

  • History of a protruding mass.
  • Degrees of fecal incontinence, (50-80% of patients) which may simply present as a mucous discharge.
  • Constipation (20-50% of patients) also described as tenesmus (a sensation of incomplete evacuation of stool) and obstructed defecation.
  • A feeling of bearing down.
  • Rectal bleeding
  • Diarrhea and erratic bowel habits.

Initially, the mass may protrude through the anal canal only during defecation and straining, and spontaneously return afterwards. Later, the mass may have to be pushed back in following defecation. This may progress to a chronically prolapsed and severe condition, defined as spontaneous prolapse that is difficult to keep inside, and occurs with walking, prolonged standing, coughing or sneezing (Valsalva maneuvers). A chronically prolapsed rectal tissue may undergo pathological changes such as thickening, ulceration and bleeding.

The first symptoms of rectal prolapse may be:

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

Causes of rectal prolapse

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.

Rectal Prolapse Treatment

Rectal prolapse won’t get better on its own. The degree of prolapse will increase over time. This process can take months or years, so there isn’t always a rush to make a decision.

If you’ve been diagnosed with rectal prolapse, you may choose to delay treatment if your symptoms are mild enough and your quality of life isn’t significantly hampered.

Surgery is the only way to effectively treat rectal prolapse and relieve symptoms. The surgeon can do the surgery through the abdomen or through the area around the anus.

Surgery through the abdomen is performed to pull the rectum back up and into its proper position. It can be done with a large incision and open surgery, or it can be done laparoscopically, using a few incisions and specially designed smaller surgical tools.

Surgery from the region around the anus involves pulling part of the rectum out and surgically removing it. The rectum is then placed back inside and attached to the large intestine. This approach is usually performed in people who aren’t good candidates for surgery through their abdomen.

Discuss your options with your doctor. If they recommend one type of surgery, you should feel comfortable asking why it’s recommended.

Types of rectal prolapse treatment

Conservative treatment

The only potentially curative treatment for complete rectal prolapse is surgery, however in those patients with medical problems that make them unfit for surgery, and those patients who have minimal symptoms, conservative measures may benefit. Dietary adjustments, including increasing dietary fiber may be beneficial to reduce constipation, and thereby reduce straining. A bulk forming agent (e.g. psyllium) or stool softener can also reduce constipation. Biofeedback retraining may be indicated to help the patient avoid straining during defecation. There is limited evidence that hypopressive exercises may be beneficial in mild pelvic organ prolapse.

Surgical

Surgery is often required to prevent further damage to the anal sphincters. The goals of surgery are to restore the normal anatomy and to minimize symptoms. There is no globally agreed consensus as to which procedures are more effective, and there have been over 50 different operations described.

Surgical approaches in rectal prolapse can be either perineal or abdominal. A perineal approach (or trans-perineal) refers to surgical access to the rectum and sigmoid colon via incision around the anus and perineum (the area between the genitals and the anus). Abdominal approach (trans-abdominal approach) involves the surgeon cutting into theabdomen and gaining surgical access to the pelvic cavity. Procedures for rectal prolapse may involve fixation of the bowel (rectopexy), or resection (a portion removed), or both. Trans-anal (endo-anal) procedures are also described where access to the internal rectum is gained through the anus itself.

How is it 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.

Natural and Home Remedies Treat and Relieve Rectal Prolapse Pain

Almost all cases require medical care, and in most cases, surgery is required to treat and cure the problem. Most cases will worsen without surgery. Occasionally, successful treatment of an underlying cause of a prolapsed rectum may resolve the problem. However, these scenarios usually involve infants or children.

The cause of this condition in many patients are constipation or straining while having a bowel movement.

These tips may help ease bowel movements and ease symptoms.

  • Try to avoid or reduce straining during a bowel movement. However, it may not be enough to correct the condition.
  • Ease constipation and straining by eating plenty of fruits and vegetables and other fiber-filled foods, and drinking lots of water.
  • Use stool softener if needed to help prevent straining during bowel movements.
  • If a doctor has diagnosed you with the condition, and with his or her guidance you may be able to manually push the prolapse back into place. Check with your doctor about whether this is something you should do yourself, and how to do it effectively.
  • For infants and children, reducing the need to strain during bowel movements with stool softeners may correct a prolapsed rectum.
  • Women may find pelvic floor exercises (for example, Kegel exercises) can help improve symptoms.
  • A doctor should always be consulted before any attempt to treat this condition at home.
  • 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 fiber. 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.

Prevention tips

Preventing rectal prolapse isn’t always possible. You can reduce your risk if you maintain good intestinal health. To help avoid constipation, in particular:

  • make high-fiber foods part of your regular diet, including fruits, vegetables, bran, and beans
  • reduce the amount of processed food in your diet
  • drink plenty of water and fluids every day
  • exercise most, if not all, days of the week
  • manage your stress with meditation or other relaxation techniques