Rectal Prolapse

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As Orange County’s highest-volume digestive treatment center, Hoag has seen, diagnosed and treated all types of digestive conditions, including complex issues of the pelvic floor and lower GI tract like rectal prolapse.

From next-generation imaging to laparoscopic and robotic-assisted surgical techniques that result in less pain and shorter recovery times, Hoag has the experience, the tools, the technology and — most importantly — the empathy you need to treat and recover from rectal prolapse.

We’re dedicated to treating every patient with the dignity, care and advanced treatment options they deserve. So don’t suffer in silence. With Hoag in your corner, you’re ready to heal. Contact us today.

What Is Rectal Prolapse?

Rectal prolapse is a medical condition that occurs when part of the rectum — the last portion of the large intestine — turns inside out and begins to protrude through the anal opening. 

Often, rectal prolapse occurs due to chronic constipation and prolonged, repeated straining during defecation. However, other factors can contribute to the condition, including weak pelvic muscles, nerve damage in the rectum or anus, previous surgery in the rectal area, medical conditions that increase pressure inside the abdomen and other issues.

What Are The Different Types Of Rectal Prolapse?

Every case is unique, but generally, rectal prolapse can be categorized into three types: internal, partial and complete.

  • Internal prolapse occurs when the rectum drops from its normal position but doesn’t protrude through the anus to create an external prolapse.
  • Complete prolapse occurs when the entire wall of the rectum protrudes through the anus.
  • Partial rectal prolapse (AKA a mucosal prolapse) involves only the inner lining of the rectum protruding through the anus.

What Are The Symptoms Of Rectal Prolapse?

Those with rectal prolapse may experience a variety of symptoms and complications, but the most noticeable and alarming symptom of partial or complete rectal prolapse is a reddish-colored mass that bulges out of the anus, often while straining the lower abdominal muscles and relaxing the anus during a bowel movement.  

Other symptoms of rectal prolapse may include:

  • Constipation or diarrhea, and sometimes both
  • Pelvic or anal pain
  • A sensation that the rectum isn’t entirely empty after a bowel movement
  • Discharge of blood and mucus while defecating
  • The inability to control bowel movements (fecal incontinence) or other disruptions of normal bowel function

Over time, if left untreated, the symptoms of rectal prolapse can worsen, to the point the rectum may protrude more frequently or might not retract back into the body without being physically pushed back inside the body. In these cases, the only treatment to fix rectal prolapse is likely rectal prolapse surgery.

However, it should be noted that many of the signs and symptoms of rectal prolapse are shared by other conditions impacting the GI tract, including Irritable Bowel Syndrome (IBS) and Crohn’s disease, so be sure to visit your doctor for an accurate diagnosis.

Why Does Rectal Prolapse Happen?

For many patients, the exact cause of rectal prolapse is unclear. However, it’s known that certain structural defects in the pelvis, pelvic organs or lower gastrointestinal tract can increase the risk, including problems like having an unusually mobile rectum, weak pelvic floor muscles or a weak anal sphincter. 

Conditions that increase the pressure inside the abdomen or weaken the pelvic floor can also cause rectal prolapse, including chronic constipation, obesity, excessive straining during bowel movements, cystic fibrosis and certain medical problems that damage the nerves or tissues of the pelvic floor.

How Is Rectal Prolapse Diagnosed?

If you visit your doctor with symptoms that might suggest a rectal prolapse, your healthcare provider will likely inquire about your medical history and the symptoms you are experiencing. 

During the visit, a rectal exam will usually be conducted to determine if it’s an internal, complete or partial prolapse. If the prolapse isn’t visible, patients might be asked to strain as if they’re having a bowel movement to push the prolapse into view. 

Depending on the results of this exam, your doctor might order certain diagnostic tests to confirm or rule out a prolapse diagnosis, determine the extent of the issue, find the cause of chronic constipation or suggest a rectal prolapse treatment. These tests may include:

What Are The Possible Complications Of Rectal Prolapse?

Rectal prolapse can lead to complications, some of which can potentially be serious. Potential complications of rectal prolapse can include:

  • Ulcers on the anus or rectum, which can bleed.
  • A prolapse that doesn’t retract back inside the body. This can be a medical emergency as the ringlike anus muscle can potentially cut off the blood supply to the protruding rectum, causing the tissues to die
  • Damage to anal sphincter muscles and nerves, which can potentially lead to bowel control issues like fecal incontinence.
What Medical Exams Or Tests Are Used To Diagnose Rectal Prolapse?

Apart from a physical exam, doctors might order diagnostic tests like defecography, colonoscopy or a lower GI series to help rule out or diagnose rectal prolapse. These tests help healthcare providers visualize the entire rectum and colon and the structure and function of the patient’s anal canal and rectum.

Is Rectal Prolapse Dangerous?

While rectal prolapse is usually not life-threatening, it can lead to complications that pose serious health risks, including cutting off the blood supply to the prolapsed rectum, which can potentially cause that portion of the rectum to die. Because of these risks, it’s important to seek a medical evaluation from your healthcare provider if you suspect you are experiencing a rectal prolapse.

Can You Still Poop If You Have a Rectal Prolapse? 

Those with complete, internal or mucosal prolapse can still have normal bowel movements. However, they may experience certain symptoms such as:

  • A sensation that the rectum isn’t entirely empty after a bowel movement.
  • Constipation or diarrhea, or sometimes both.
  • Expelling blood or mucus during bowel movements
  • Fecal incontinence, which is the inability to control the release of feces from the bowels.

During a bowel movement, the prolapsed tissue can cause discomfort and can affect the passage of stool, but it doesn’t prevent the act of defecation. However, the severity of the prolapse and the symptoms experienced can vary from person to person. 

How Is Rectal Prolapse Treated?

The primary treatment for prolapse of the rectum is surgery to reconnect the rectum to internal structures, hold it in a more natural position and keep it from protruding through the anus.

Open abdominal surgery was once the only way to correct rectal prolapse. Today, however, colon and rectal surgeons often do the surgery to repair a prolapsed rectum laparoscopically, using small instruments inserted through slits in the abdomen or pelvic region. Fixing rectal prolapse using these less-invasive methods can lessen trauma to the anus, rectum and abdominal muscles, reduce the amount of post-surgery pain and shorten recovery times.

After surgery, there’s a possibility that the condition can come back. To reduce the risk of a prolapse recurring, it’s important for patients to manage constipation symptoms with a high-fiber diet or stool softeners, and to avoid straining during bowel movements.

Can Rectal Prolapse Be Treated Without Surgery?

Sometimes, an internal or partial prolapse can be managed without surgery by addressing the underlying cause, such as chronic dry stools or excessive straining during bowel movements. If these treatments don’t work or if the prolapse gets worse, however, surgical correction will have to be considered.

Are There Any Medications To Treat Rectal Prolapse?

While surgery is the primary way physicians treat rectal prolapse, certain medications like stool softeners might be prescribed for patients to keep a partial or internal prolapse from getting worse or prevent the condition from recurring after surgery to repair a prolapse.

Who Is Most At Risk To Develop Rectal Prolapse?

Rectal prolapse is more common in older adults, especially those over 50, and is more prevalent in women. Other issues or risk factors that can increase the odds of developing a rectal prolapse include:

  • A history of chronic constipation and prolonged straining while having bowel movements, which are among the most important risk factors for developing a rectal prolapse
  • Childbirth with prolonged or difficult labor
  • Those with a weakened anal sphincter, or weak pelvic floor muscles
  • Cystic fibrosis
  • Having a previous history of pelvic or rectal surgery
  • Those with conditions that can increase pressure in the abdominal cavity, large intestine or rectum, including constipation, straining for long periods during defecation, benign prostatic hypertrophy and COPD
  • Abusing laxatives to prevent constipation or as part of an eating disorder
  • Having a stroke or dementia
  • Having a disorder that impacts the nerves or spinal cord, including a spinal cord injury
How Can I Reduce My Risk Of Developing Rectal Prolapse?

Most people will never develop a rectal prolapse. However, for those who are at increased risk, ways to prevent rectal prolapse can include managing constipation, avoiding obesity through diet and regular exercise, not straining too much during bowel movements and maintaining strong pelvic floor muscles.

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