What is Rectal Prolapse?

Symptoms of Rectal Prolapse

The severity of the symptoms varies among between patients and depends upon the severity of condition. The rectal prolapse may be complete or incomplete.

• Protrusion of the rectum occurs during passage of stool. Initially, the rectum returns to a normal position but later it needs to be moved by hand.
• Lower abdomen or anal discomfort, bleeding, and the passage of mucus.
• Feeling of sitting on a ball.
• Bowel incontinence.
• Feeling of incomplete emptying of the rectum.

Causes of Rectal Prolapse

The rectum is normally anatomically positioned via the pelvic support system. A rectal prolapse occurs when the normal support system of the rectum becomes too weak. Anal sphincter muscles also become weak, resulting in difficulty in controlling the bowels. The condition causes leakage of stool or mucus.

Women are at increased risk to damage this pelvic support system during the childbirth, hence rectal prolapse is more common in women.

Risk Factors of Rectal Prolapse

• Longstanding constipation and straining to have bowel movements.
• Childbirth complications
• Old age
• Connective tissue disorders running in family.
• Generalized pelvic floor dysfunction.
• Neurological problems (brain, spinal cord, or nerves).

Complications of Rectal Prolapse

The common complications of rectal prolapse include:

• Inability of rectum to return back inside the body.
• Rectal ulceration and bleeding.
• Reduced blood supply to the rectum resulting in ischemia and gangrene.
• Fever.
• Sepsis.
• Anemia.

Diagnosis of Rectal Prolapse

Your doctor will first take a detailed history and will perform the relevant physical examination. You may be asked to strain as if having a bowel movement to see the size of the prolapse. Sometimes, a rectal prolapse may be internal and cannot be seen from outside, making the diagnosis of rectal prolapse more difficult. Your doctor may also advise for additional tests including:

• A specialized x-ray examination, called proctogram.
• Anorectal manometry to measure the pressure of anal sphincters.
• Proctosigmoidoscopy to visualize the rectum and anus.

Treatment of Rectal Prolapse

Treatment of rectal prolapse depends on severity of rectal prolapse, age of the person, and presence or absence of other pelvic abnormalities. Initial treatment options are life-style changes followed by surgery in severe cases. The life-style changes include:

• Relieving chronic constipation by increasing dietary fiber intake and stool softeners.
• Avoiding straining while on the toilet.
• Increasing water intake.
• Increasing physical exercise.
• Conducting pelvic floor exercises such as Kegel exercises.

Surgical Management of Rectal prolapse

Surgery is used to secure the rectum into its anatomical place. It can be performed either through the person’s abdomen (laparoscopic rectopexy) or through anus (perineal approach). Although repair through abdominal surgery may give better long-term results, older people may be advised to undergo surgical correction through the anus, because of early and easy recovery. Your doctor will advise which surgery is better for you.

Follow Up

More than half of the patients are completely relieved of symptoms after the surgery. Your doctor will advise you for regular post-surgery follow ups. After surgery, you should do the following:

• Take more rest.
• Avoid heavy lifting or straining for a few weeks.
• Avoid straining during bowel movements.
• Prevent constipation by eating high-fiber foods and drinking plenty of water.