What is rectal prolapse?

Rectal prolapse is a condition in which the rectum (the lower end of the colon, located just above the anus) turns itself inside out. In the earliest phases of this condition, the rectum does not stick out of the body, but as the condition worsens, it may start to protrude. When the rectum protrudes, it’s often associated with weakness of the anal sphincter muscle and can result in leakage of stool or mucus. Rectal prolapse is more common in women than men.

There are several contributing factors to the development of rectal prolapse. It may be the result of a lifelong habit of straining to have bowel movements, or it may be the delayed result of the stresses involved in childbirth. In rare cases, there may be a genetic predisposition in some families.

Rectal prolapse seems to be a part of the aging process in many patients. There is weakening of the ligaments that support the rectum inside the pelvis combined with a loss of tightness in the anal sphincter muscle.

In other cases, neurological problems – such as spinal cord transection or spinal cord disease – can lead to prolapse. In most cases, however, no single cause can be identified.

Some of the symptoms of rectal prolapse may be the same as those experienced with hemorrhoids – i.e. bleeding and/or tissue that protrudes from the rectum. Rectal prolapse, however, involves a segment of the bowel located higher up within the body, while hemorrhoids develop near the anal opening.

How is rectal prolapse diagnosed?

Rectal prolapse is diagnosed by taking a careful medical history and by performing a complete anorectal examination. To demonstrate the prolapse, patients may be asked to “strain” as if having a bowel movement or to sit on the commode and “strain” prior to examination.

When the rectal prolapse doesn’t protrude, a special x-ray called a videodefecogram may prove helpful. This procedure involves taking x-ray pictures while a patient is having a bowel movement. The results of this exam can help to determine whether surgery may be beneficial and, if so, which operation is appropriate.

How is rectal prolapse treated?

Although constipation and straining may be the causes of rectal prolapse, correcting these problems may not improve the prolapse once it has developed. Fortunately, there are many different ways to correct rectal prolapse surgically.

There are many factors to consider before deciding upon the correct surgery. These factors include the patient’s age and physical condition, the extent of the prolapse and, of course, the results of tests such as the anorectal manometry.

Success treatment for rectal prolapse depends on a number of factors, including the status of a patient’s anal sphincter muscle before surgery and whether the prolapse is internal or external. If the anal muscle was weakened prior to treatment of the prolapse, it may regain significant strength afterward.

Of course, after surgical correction, chronic constipation and straining must be avoided. A great majority of patients are significantly helped or completely relieved of symptoms by the appropriate procedure.