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Rectal prolapse is a condition in which the rectum (a portion of the colon) looses its internal support and protrudes from the anus. Rectal prolapse may be internal but in advanced stages, it can be seen or felt outside the body. When this occurs, it is referred to as a complete rectal prolapse.

Rectal prolapse can occur due to a lifelong habit of straining during bowel movement, hereditary factors, stresses due to childbirth or as part of the aging process when pelvic and anal sphincter muscles weaken. It occurs in women more often than men and its symptoms can often mimic those of hemorrhoids.

Stool softeners or other treatments for constipation may help but will not reverse the prolapse once it has developed. With complete rectal prolapse, incontinence (uncontrolled leakage of stool) can occur and surgical treatment may become necessary.

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Types

There are three chief conditions which come under the title rectal prolapse:

Full-Thickness rectal prolapse describes the entire rectum protruding through the anus

Mucosal prolapse describes only the rectal mucosa (not the entire wall) prolapsing

Internal intussusception wherein the rectum collapses but does not exit the anus

Symptoms

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

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.

Diagnosis

A physician can often diagnose this condition with a careful history and a complete anorectal examination. To demonstrate the prolapse, patients may be asked to sit on a commode and "strain" as if having a bowel movement.

Occasionally, a rectal prolapse may be "hidden" or internal, making the diagnosis more difficult. In this situation, an x-ray examination called a videodefecogram may be helpful. This examination, which takes x-ray pictures while the patient is having a bowel movement, can also assist the physician in determining whether surgery may be beneficial and which operation may be appropriate. Anorectal manometry may also be used to evaluate the function of the muscles around the rectum as they relate to having a bowel movement.

Treatment

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Treatment depends on the age of the patient and the severity of the prolapse, but could 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.

In cases of mucosal prolapse, the structures are secured in place with surgical rubber bands.

Surgery is sometimes used to secure the rectum into place, performed through the abdomen or via the 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. While abdominal surgery may give better long term results, elderly patients may be advised to undergo surgical correction via the anus, since it is easier to recover from this procedure.

Surgery

The goal of all of the surgical techniques involved in correcting a prolapsed rectum is to attach or secure the rectum to a backside (or posterior) part of the inner pelvis. Surgery is performed through either the abdomen or the perineum.

Surgery through the abdomen
- Typically performed in younger or healthier people
- Type of abdominal surgery usually determined by severity of associated constipation
- Associated with higher morbidity rate than perineal approach but lower recurrence rate of prolapse
- Performed under general anesthesia
- Usually involves a hospital stay of 3-7 days

Perineal approach
- Typically performed in elderly people or people in poor health
- Approach for people who cannot tolerate general anesthesia
- Associated with higher recurrence rate than abdominal approach
- Usually involves short hospital stay

Complications

Some of the complications of rectal prolapse include:

Risk of damage to the rectum, such as ulceration and bleeding

Incarceration, which means the rectum can’t be manually pushed back inside the body

Strangulation of the rectum, which means the blood supply is reduced

Death and decay (gangrene) of the strangulated section of rectum.

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