Rectal Prolapse: Symptoms, Causes, Treatment

What are the symptoms of rectal prolapse?

Rectal prolapse occurs when part or all of the rectum slips out of its normal place and protrudes through the anus. The symptoms can vary depending on the severity of the condition, but common symptoms include:

1. Visible Protrusion: A bulging or protruding tissue from the anus, especially during bowel movements. This tissue may retract on its own or may need to be pushed back manually.
2. Fecal Incontinence: Involuntary leakage of stool or mucus, which can occur due to weakening of the anal sphincter muscles.
3. Constipation: Difficulty passing stool or feeling of incomplete evacuation. Some people may need to use manual pressure to aid in bowel movements.
4. Rectal Bleeding: Bright red blood may appear in the stool or on toilet paper after wiping.
5. Mucus Discharge: Excessive mucus from the rectum can be noticed, often associated with irritation or itching around the anus.
6. Pain or Discomfort: Discomfort or pain in the rectal area, especially during bowel movements. There may also be a sensation of pressure or a feeling of a mass or lump.
7. Feeling of Fullness: A persistent feeling of fullness or the sensation that something is falling out of the rectum.

If someone is experiencing symptoms of rectal prolapse, it is important to seek medical attention for an accurate diagnosis and appropriate treatment.

What are the causes of rectal prolapse?

Rectal prolapse can be caused by a combination of factors, often related to weakening of the muscles and ligaments that support the rectum. Some of the main causes and contributing factors include:

1. Chronic Constipation or Straining: Repeated straining during bowel movements, often due to chronic constipation, can weaken the muscles and ligaments supporting the rectum, leading to prolapse over time.
2. Childbirth: Vaginal childbirth, especially multiple or difficult deliveries, can weaken the pelvic floor muscles and increase the risk of rectal prolapse in women.
3. Pelvic Floor Dysfunction: Weakness or dysfunction in the muscles and tissues of the pelvic floor can lead to rectal prolapse. This is more common in women, especially after menopause.
4. Age: As people age, the tissues and muscles in the pelvic area naturally weaken, increasing the risk of rectal prolapse. It is more common in older adults.
5. Previous Pelvic Surgery: Surgeries in the pelvic area, including hysterectomy or rectal surgery, can weaken the supporting structures and increase the risk of prolapse.
6. Chronic Diarrhea: Repeated episodes of diarrhea can lead to straining, which, like chronic constipation, can contribute to the weakening of the rectal supports.
7. Neurological Disorders: Conditions that affect the nerves and muscles controlling the pelvic floor, such as spinal cord injuries or multiple sclerosis, can increase the risk of rectal prolapse.
8. Cystic Fibrosis: In children, cystic fibrosis can be a contributing factor, as the thick mucus and chronic coughing associated with the condition can put strain on the pelvic floor.
9. Genetic Predisposition: A family history of rectal prolapse or pelvic floor disorders can increase the risk, as some people may have a genetic predisposition to weaker pelvic tissues.
10. Heavy Lifting: Frequent heavy lifting can put strain on the pelvic muscles and contribute to the development of rectal prolapse.
11. Chronic Obstructive Pulmonary Disease (COPD): Chronic coughing associated with COPD can increase intra-abdominal pressure, leading to a higher risk of rectal prolapse.

Rectal prolapse is more common in women, particularly older women, but it can also occur in men and children.

What is the treatment for rectal prolapse?

Treatment for rectal prolapse varies based on the severity of the condition and the overall health of the patient, involving both non-surgical and surgical approaches.

Non-surgical treatments focus on lifestyle changes and supportive care. A high-fiber diet and the use of stool softeners can help alleviate constipation and reduce straining during bowel movements, which may prevent the prolapse from worsening. Patients are also encouraged to avoid straining when defecating. Pelvic floor exercises, such as Kegel exercises, can strengthen the muscles that support the rectum and may help in mild cases. For some, manually pushing the prolapsed rectum back into place may be effective, either on their own or with the help of a healthcare provider.

In cases where non-surgical methods are insufficient or the prolapse is more severe, surgery may be recommended. Abdominal surgery, such as rectopexy, involves securing the rectum to the sacrum to prevent further prolapse. This procedure can be done through open surgery or laparoscopically. For patients with associated constipation, a resection rectopexy may be performed, which includes removing a portion of the colon.

Perineal surgery is another option, particularly for elderly patients or those unable to undergo abdominal surgery. The Delorme’s procedure involves removing the inner lining of the prolapsed rectum and folding the outer layer to shorten the rectum. The Altemeier procedure, or perineal rectosigmoidectomy, removes the prolapsed rectum through the perineum, with the remaining rectum reattached.

In some cases, transanal surgery might be performed, where the rectum is pulled through the anus and excess tissue is removed. After surgery, physical therapy may be recommended to strengthen the pelvic floor muscles, and regular follow-up care is essential to monitor recovery and prevent recurrence. Post-operative care is also important to manage any complications, such as infection or bleeding.

Overall, the choice of treatment depends on individual factors such as age, health, and the severity of the prolapse, with surgery often providing the most effective resolution in severe cases.