What is Rectal Prolapse?
Rectal prolapse is a condition where part or all of the rectum (the final section of the large intestine) slips outside the anus. It can occur in varying degrees, from partial prolapse of the inner rectal lining to full-thickness protrusion of the entire rectal wall. While not life-threatening, rectal prolapse can cause significant discomfort, embarrassment, and impact daily life. It is more common in older adults, especially women, but can also affect children and younger individuals.
What Causes Rectal Prolapse?
Several factors may contribute to the development of rectal prolapse, including:
- Chronic constipation or straining during bowel movements
- Weakness or damage to pelvic floor muscles or anal sphincter
- Previous surgery or injury to the pelvic area
- Neurological conditions such as spinal cord disorders or multiple sclerosis
- Long-term diarrhea or chronic cough
- Aging, which naturally weakens supporting tissues
- Pregnancy and childbirth, especially multiple vaginal deliveries
- Congenital anomalies in children
What Are the Symptoms of Rectal Prolapse?
Symptoms can vary depending on the severity of the prolapse and may include:
- A visible bulge or protrusion from the anus, especially after bowel movements
- A sensation of incomplete bowel emptying
- Mucus or stool leakage (fecal incontinence)
- Rectal bleeding or irritation
- Discomfort or pain during bowel movements
- Feeling of pressure or fullness in the rectum
- Constipation or difficulty passing stool
How Is Rectal Prolapse Diagnosed?
Diagnosis usually involves a physical examination and additional tests to determine the extent and cause of the prolapse:
- Visual and digital rectal exam to assess the protrusion
- Defecography (X-ray during simulated bowel movement)
- Colonoscopy or sigmoidoscopy to rule out polyps or tumors
- Anal manometry to evaluate muscle strength
- MRI or ultrasound to check pelvic floor function
What Are the Treatment Options for Rectal Prolapse?
Treatment depends on the type and severity of the prolapse, as well as the patient’s overall health:
- Lifestyle changes: High-fiber diet, increased fluid intake, and stool softeners to prevent constipation
- Pelvic floor exercises: Strengthening muscles to support the rectum
- Manual reduction: Gently pushing the rectum back into place (temporary relief)
- Medications: To treat underlying constipation or diarrhea
- Surgical intervention: Recommended for moderate to severe prolapse; options include:
- Rectopexy (attaching the rectum to the pelvic wall)
- Resection rectopexy (removing a portion of the bowel)
- Perineal procedures for frail or elderly patients
Can Rectal Prolapse Cause Complications?
Yes, untreated or severe rectal prolapse can lead to:
- Chronic fecal incontinence
- Rectal ulceration or bleeding
- Trapped or strangulated prolapse, which is a medical emergency
- Recurrent infections or irritation
- Social embarrassment and reduced quality of life