Understanding Rectal Prolapse: Causes and Treatments

Written by Medicover Team and Medically Reviewed by Dr Manoj Kumar D , General Surgeons

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Rectal prolapse is a medical condition that can significantly impact a person's quality of life. Understanding its causes, symptoms, and treatment options is crucial for effective management.

In this article, we delve deep into rectal prolapse, exploring its grading system, distinguishing it from haemorrhoids, and discussing both conservative and surgical treatment options.

What Are the Symptoms of Rectal Prolapse?

Recognizing the symptoms of rectal prolapse is essential for timely diagnosis and treatment. Key symptoms include:

Visible Protrusion: The most evident symptom is a visible bulge or protrusion from the anus, especially during bowel movements.
Anal Discomfort: Patients may experience pain, itching, or a sensation of incomplete evacuation after bowel movements.
Incontinence: In severe cases, there may be faecal incontinence or leakage of mucus.

What Causes Rectal Prolapse?

Rectal prolapse develops when the muscles, ligaments, and other supporting structures of the rectum become weakened or damaged. Several anatomical, neurological, and lifestyle factors can contribute to this condition and increase the likelihood of the rectum slipping through the anus.

Anatomical and Physiological Factors

The primary causes of rectal prolapse are often related to anatomical and physiological changes within the body. These can include:

Weakness of the Pelvic Floor Muscles: The muscles and ligaments supporting the rectum may weaken due to ageing, childbirth, or chronic straining during bowel movements.
Neurological Conditions: Diseases such as multiple sclerosis or spinal cord injuries can impact the nerves that control the rectum, leading to prolapse.
Chronic Constipation or Diarrhea: Persistent straining during bowel movements can weaken the pelvic floor muscles over time.

Secondary Causes

Other factors that may contribute to rectal prolapse include:

Genetic Predisposition: Some individuals may be genetically prone to developing rectal prolapse.
Previous Surgeries: Surgical procedures involving the pelvic area can sometimes weaken the support structures of the rectum.

When Should You See a Doctor for Rectal Prolapse?

Rectal prolapse should be evaluated promptly, especially if symptoms worsen or interfere with daily activities. Early diagnosis helps prevent complications and allows timely treatment. Rectal prolapse is typically treated by colorectal surgeons, general surgeons, and gastroenterologists, depending on its severity and underlying cause.

You should see a doctor if you have:

A visible bulge from the anus during or after bowel movements.
Persistent anal pain, discomfort, bleeding, or mucus discharge.
Difficulty controlling bowel movements or a feeling of incomplete bowel emptying.

Get medical help immediately if:

The prolapsed rectum cannot be pushed back inside.
You develop severe pain, heavy bleeding, or the prolapsed tissue becomes dark, swollen, or discolored.
You have fever, severe abdominal pain, or signs of bowel obstruction.

These could be signs of a serious complication of rectal prolapse that requires prompt medical care.

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How is Rectal Prolapse Diagnosed?

Rectal prolapse is diagnosed through a combination of medical history, physical examination, and imaging or functional tests when needed. These evaluations help confirm the diagnosis, determine the severity of the prolapse, and identify any underlying conditions that may influence treatment planning.

Medical History and Physical Examination

Your doctor will ask about your symptoms, bowel habits, and medical history. A physical examination, including examination of the anal and rectal area, may be performed while you strain to assess the extent of the prolapse.

Diagnostic Tests

Defecography: An imaging study that evaluates how the rectum functions during bowel movements.
Colonoscopy: May be performed to rule out other conditions affecting the rectum or colon.
Anal Manometry: Measures the strength and function of the anal sphincter muscles.
MRI or CT Scan: May be recommended in selected cases to evaluate pelvic floor structures or associated abnormalities.

What is the Treatment for Rectal Prolapse?

Treatment for rectal prolapse depends on the severity of the condition and the patient's overall health. Both conservative and surgical options are available.

Conservative Treatments

For mild cases of rectal prolapse, conservative treatments may be effective. These include:

Dietary Changes: Increasing fibre intake and staying hydrated can help prevent constipation and reduce straining during bowel movements.
Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises such as Kegels can provide better support to the rectum.
Stool Softeners: Medications to soften stools can reduce straining and alleviate symptoms.

Surgical Treatments

In more severe cases or when conservative treatments fail, surgical intervention may be necessary. Several surgical options are available, each tailored to the patient's specific condition.

Rectopexy

Rectopexy is a surgical procedure that involves repositioning and securing the rectum to its original position. This can be done through open surgery or minimally invasive techniques such as laparoscopy. Rectopexy is often recommended for Grade II and III prolapse.

Perineal Procedures

Perineal procedures, such as the Altemeier procedure, involve removing the prolapsed rectum through the perineum (the area between the anus and the genitals). This approach is less invasive and may be suitable for elderly or high-risk patients.

Resection Rectopexy

Resection rectopexy combines rectal resection (removal of a portion of the rectum) with rectopexy. This procedure is typically reserved for patients with redundant (excess) rectal tissue.

Post-Surgical Care

Post-surgical care is crucial for a successful recovery. Patients may need to follow a specific diet, avoid heavy lifting, and engage in pelvic floor exercises to prevent recurrence.

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What is the Difference Between Rectal Prolapse and Hemorrhoids?

It's crucial to differentiate between rectal prolapse and haemorrhoids, as the treatment approaches for these conditions differ significantly.

Rectal Prolapse

Rectal prolapse involves the entire wall of the rectum protruding through the anus. This condition often requires surgical intervention to correct.

Hemorrhoids

Hemorrhoids, on the other hand, are swollen blood vessels in the anal canal. They can cause symptoms such as bleeding, itching, and discomfort but typically do not involve the rectal wall's protrusion. Hemorrhoids are usually treated with lifestyle changes, medications, or minimally invasive procedures.

How is Rectal Prolapse Graded?

Rectal prolapse is graded based on the extent of the prolapse. This grading system helps determine the appropriate treatment approach.

Grade I: Partial Prolapse

In Grade I prolapse, only the mucosa (the innermost lining of the rectum) protrudes through the anus. This is often referred to as a mucosal prolapse.

Grade II: Complete Prolapse

Grade II prolapse involves the full thickness of the rectal wall protruding through the anus. This is the most common and most severe form of rectal prolapse.

Grade III: Full-Thickness Prolapse with Incarceration

In Grade III prolapse, the entire rectal wall protrudes, and the prolapsed segment becomes trapped outside the anus, leading to incarceration. This condition often requires emergency surgical intervention.

Frequently Asked Questions

1. What is rectal prolapse?

Rectal prolapse is a condition in which part or all of the rectum slips through the anus. It can cause discomfort, mucus discharge, bleeding, and difficulty controlling bowel movements.

2. What are the treatment options for rectal prolapse?

Treatment depends on the severity of the prolapse. Mild cases may be managed with stool softeners, dietary changes, pelvic floor exercises, and treatment of constipation. More severe cases usually require surgery, such as rectopexy or perineal repair.

3. How does rectal prolapse differ from hemorrhoids?

Rectal prolapse occurs when the rectum protrudes through the anus, whereas hemorrhoids are swollen veins in the rectum or anus. Although both can cause bleeding and discomfort, they are different conditions and require different treatments.

4. What are the symptoms of rectal prolapse?

Symptoms include a bulge or tissue protruding from the anus, pain or discomfort, rectal bleeding, mucus discharge, constipation, fecal incontinence, and a feeling of incomplete bowel emptying.

5. What are the risk factors for rectal prolapse?

Risk factors include chronic constipation, chronic straining during bowel movements, aging, pelvic floor muscle weakness, previous pelvic surgery, multiple vaginal deliveries, and neurological disorders.

6. How do you fix rectal prolapse?

Definitive treatment is usually surgical. Depending on the patient's age, overall health, and severity of the prolapse, procedures such as rectopexy or perineal repair may be recommended. Conservative measures can help relieve symptoms but do not correct a complete prolapse.

7. What is the cause of rectal prolapse?

Rectal prolapse is caused by weakening of the muscles and ligaments that support the rectum. Contributing factors include chronic constipation, prolonged straining, aging, pelvic floor dysfunction, childbirth, and nerve damage.

8. What happens if rectal prolapse is left untreated?

Without treatment, rectal prolapse can worsen over time and lead to complications such as fecal incontinence, chronic constipation, rectal ulcers, bleeding, and, in rare cases, strangulation of the prolapsed rectum requiring emergency treatment.