Overview and Facts about Rectal Prolapse
Rectal prolapse is a digestive health condition in which the rectum, which sits at the end of the large intestine, becomes detached from the inside of the body and slides out through the opening of the anus – effectively turning it “inside out.”
Overall, rectal prolapse affects relatively few people (2.5 cases for every 100,000 people). The condition is more uncomfortable than dangerous, but those who do have rectal prolapse often feel embarrassed and have a lower quality of life.
Symptoms and Signs of Rectal Prolapse
A prolapsed rectum may be evidenced by a number of symptoms, including constipation and bleeding from the rectum. Some people notice a lump or swelling at the rectum opening when they pass a bowel movement, but over time the prolapse will protrude permanently and happen even when a person sneezes, stands up or coughs.
Some people may experience an internal rectal prolapse, which is different in that the prolapse will not protrude. However, the person may feel as if they have not passed everything during a bowel movement.
Other symptoms of a rectal prolapse include:
- Bright red blood that comes out of the rectum
- Constipation, which is present in 25–50 percent of people who have a rectal prolapse.
- Having a difficult time controlling bowel movements. This occurs in up to 75 percent of all cases.
Causes and Risk Factors of Rectal Prolapse
Rectal prolapse primarily affects adults. Women over 50 face a six-fold greater risk for developing it when compared with men. Straining associated with constipation, childbirth and conditions that cause heavy coughing are thought to be causes for rectal prolapse, but there is no definitive cause known.
Some doctors believe certain conditions that affect the nerves could ultimately play a role in rectal prolapse, including:
Tests and Diagnosis of Rectal Prolapse
To determine the presence of rectal prolapse, during the initial visit a colon and rectal specialist will review your medical history. They will also perform an anorectal exam to make sure a rectal prolapse is not internal and hidden from view. You may be asked to sit on a toilet and strain, as if you are trying to have a bowel movement.
Another test to diagnose rectal prolapse is a video defecogram, which is essentially a series of x-rays taken while you are having a bowel movement to review muscle movement. Similarly, anorectal manometry evaluates muscle ability in the pelvis, rectum and anus during a bowel movement.
Treatment and Care for Rectal Prolapse
Treating and repairing rectal prolapse typically involves some manner of surgery. The appropriate surgical option for you will depend on your age, physical condition and the extent of the prolapse. To treat the prolapse, the rectum can either be removed or pulled back in and anchored. The surgical options to correct this include:
- An open approach, which involves abdominal repair through traditional surgery
- Laparoscopic surgery
- Robotically assisted surgery