Rectal prolapse occurs when the rectum (the last section of the large intestine) falls from its normal position within
the pelvic area. (The word “prolapse” means a falling down or slipping of a body part from its usual position.)
The term “rectal prolapse” can describe three types of prolapse:
Rectal prolapse is common in older adults with a long-term history of constipation or a weakness in the pelvic floor muscles. It is more common in women than in men and even more common in women over the age of 50 (postmenopausal women) but occurs in younger people too. Rectal prolapse can also occur in infants – which could be a sign of cystic fibrosis – and in older children.
The symptoms of rectal prolapse include the feeling of a bulge or the appearance of reddish-colored mass that extends outside the anus. At first, this can occur during or after bowel movements and is a temporary condition. However, over time – due to an ordinary amount of standing and walking – the end of the rectum may extend out of the anal canal and needs to be pushed back up into the anus by hand.
Other symptoms of rectal prolapse include pain in the anus and rectum and rectal bleeding from the inner lining of the rectum. These are rarely life-threatening symptoms. Fecal incontinence is another symptom. Fecal incontinence refers to leakage of mucus, blood or stool from the anus. This occurs as a result of the rectum stretching the anal muscle. Symptoms change as the rectal prolapse itself progresses.
Rectal prolapse can occur as a result of many conditions, including:
No. Rectal prolapse results from a sagging of the last portion of the large intestine. Hemorrhoids are swollen blood vessels that develop in the anus and lower rectum. Hemorrhoids can produce anal itching and pain, discomfort, and bright red blood on toilet tissue. Early rectal prolapse can mimic internal hemorrhoids that have slipped out of the anus (ie, prolapsed), making it difficult to tell these two conditions apart.
First, your doctor will take your medical history and will perform a rectal exam. You may be asked to “strain” while sitting on a commode to mimic an actual bowel movement. Being able to see the prolapse helps your doctor confirm the diagnosis and plan treatment.
Other conditions are could be present along with rectal prolapse such as urinary incontinence, bladder prolapse and vaginal/uterine prolapse. Because of the variety of potential problems, urologists, urogynecologists and other specialists are often team together to share evaluations and make joint treatment decisions. In this way, surgeries to repair any combination of these problems can be done at the same time.
There are several tests doctors can use to diagnose rectal prolapse and other pelvic floor problems. Tests used to evaluate and make treatment decisions include:
In some cases of very minor, early prolapse, treatment can begin at home with the use of stool softeners and by pushing the fallen tissue back up into the anus by hand. However, surgery is usually necessary to repair the prolapse. There are several surgical approaches. The surgeon’s choice depends on patient’s age, other existing health problems, the extent of the prolapse, results of the exam and other tests, and the surgeon’s preference and experience with certain techniques.
Abdominal and rectal (also called perineal) surgery are the two most common approaches to rectal prolapse repair.
Abdominal procedure refers to making an incision in the abdominal muscles to view and operate in the abdominal cavity. It is usually performed under general anesthesia and is the approach most often used in healthy adults. The two most common types of abdominal repair are rectopexy (fixation [reattachment] of the rectum) and resection (removal of a segment of intestine) followed by rectopexy. Resection is preferred for patients with severe constipation. Rectopexy can also be performed laparoscopically through small key-hole incisions or robotically.
Rectal procedures are often used in older patients and in patients with more medical problem. Spinal anesthesia or an epidural may be used instead of general anesthesia in these patients. The two most common rectal approaches are the Altemeier and Delorme procedures.
As with any surgery, anesthesia complications, bleeding, and infection are always risks.Other risks and complications from surgeries to repair prolapse include:
After surgery, constipation and straining should be avoided. Fiber, fluids, stool softeners, and mild laxatives can be used.
Success can vary depending on the condition of supporting tissues and the age and health of the patient. Abdominal procedures are associated with a lower chance of the prolapse reoccurring compared with perineal procedures. However, in most patients, surgery fixes the prolapse.
The average length of hospital stay is three to five days but this varies depending on a patient’s other existing health conditions. Complete recovery can usually be expected in three months; however, patients should avoid straining and heavy lifting for at least six months. In fact, the best chance for preventing prolapse from recurring is to make a lifetime effort to avoid straining and any activities that increase abdominal pressure.
© Copyright 1995-2018 The Cleveland Clinic Foundation. All rights reserved.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.
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