Rectal prolapse

What is rectal prolapse?

Rectal prolapse refers to the protrusion of rectum within and outside of the anal opening.

It is classified according to the extent of the prolapse. This includes:1

  • Internal prolapse – where the rectum has prolapsed internally, but isn’t protruding through the anal opening
  • Mucosal prolapse – the inner lining of the rectum protrudes out of the anal opening
  • External prolapse – the rectum completely protrudes out of the anal opening

Rectal prolapse is significantly more common in women compared to men, and primarily occurs in children and the elderly.2

Signs and symptoms of rectal prolapse

For early-stage rectal prolapse, the rectum ‘falls out’ during a bowel motion and returns to its normal position afterward without any intervention. When rectal prolapse persists, the rectum permanently protrudes from the anal opening and needs to be pushed back in after a bowel motion.2,3

The symptoms experienced will depend on the severity of the rectal prolapse, and tend to become more severe as the prolapse worsens. They may include:1,2

  • Prolapsing mass out of the anus after straining on the toilet
  • Painful and discomfort
  • Blood and mucus during bowel movements
  • Constipation
  • An incomplete feeling following a bowel motion
  • Incontinence
  • Poor control of bowels

Diagnosis

Diagnosis of rectal prolapse is generally provided during consultation with a doctor, who will inspect for any signs of rectal protrusion. The patient may be asked to squat and strain/bear down while being observed to identify the prolapse. Other tests that may be undertaken include ultrasounds, special x-rays (such as a proctogram) and analysis of muscle function. A colonoscopy will be necessary to rule out existing polyps or cancer before considering treatment for rectal prolapse.

Treatment

Treatment for rectal prolapse depends on a number of factors, including your age, prolapse severity and the presence of any existing colorectal conditions.

Treatment options include:1,2

  • Prevention of constipation through diet and lifestyle changes – most successful for rectal prolapse in young children.
  • Manual reduction – where the rectal prolapse is reduced using gentle digital pressure, which may be assisted through sedation or local perianal anaesthesia. This is particularly important to prevent strangulation and gangrene of the prolapsed tissue
  • Surgery – performed through the abdomen via laparoscopic or open surgery; or through the anus to return the rectum to its normal position

Frequently asked questions

What causes rectal prolapse?

The exact cause of rectal prolapse isn’t known, but risk factors include:1

  • Constipation
  • Straining during bowel movements
  • Weakened pelvic floor and sphincter muscles
  • Having a family history of rectal prolapse
  • Chronic conditions such as chronic obstructive pulmonary disease (COPD)
  • Congenital bowel conditions
  • Trauma to the lower back

References

For a full list of references, click here.
  1. Department of Health & Human Services Victoria. (2014). Rectal prolapse. Retrieved on 20 November 2019 from https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/rectal-prolapse
  2. Colorectal Surgical Society of Australia and New Zealand. (2013). Rectal Prolapse. Retrieved on 20 November 2019 from https://cssanz.org/index.php/patients/rectal-prolapse
  3. Australian Government Department of Health. (n.d). Rectal prolapse. Retrieved on 20 November 2019 from http://www.bladderbowel.gov.au/all/rectalprolapse.htm

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