Rectal Prolapse

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• Facts and Definition of Rectal Prolapse
• What Is Rectal Prolapse?
• How Does Rectal Prolapse Occur (Causes)?
• Do Hemorrhoids Cause Rectal Prolapse?
• What Are the Signs and Symptoms of Rectal Prolapse?
• How Is Rectal Prolapse Diagnosed?
• Can Medication Cure Rectal Prolapse?
• What Natural or Home Remedies Treat and Relieve Rectal Prolapse Pain?
• Can Rectal Prolapse Be Treated Without Surgery?
• What Is Rectal Prolapse Surgery?
• What Is the Surgery Recovery Time?
• How Can You Prevent Rectal Prolapse?
• What Is the Outlook and Prognosis for a Person with Rectal Prolapse?
• What Does Rectal Prolapse Look Like (Pictures)?
• Read more on Rectal Prolapse from Healthwise

• The term rectum refers to the lowest 12-15 centimeters of the large intestine. The rectum is located just above the anal canal. Normally, the rectum is securely attached to the pelvis with the help of ligaments and muscles that hold it in place.
• Causes of this condition include factors such as age of 40 years, long-term constipation, the stress of childbirth, or large hemorrhoids (large, swollen veins inside the rectum) that may cause these ligaments and muscles to weaken, causing the rectum to prolapse, meaning it slips or falls out of place.
• Other risk factors of include long-term diarrhea, long-term straining during defecation, previous surgery, cystic fibrosis, chronic obstructive pulmonary disease, whooping cough, multiple sclerosis, and paralysis.
• Signs and symptoms of include:
  • Pain during bowel movements
  • Mucus or blood discharge from the protruding tissue
  • Fecal incontinence
  • A loss of urge to defecate
  • Awareness of something protruding upon wiping
• Medical treatment helps ease the symptoms of a prolapsed rectum temporarily or to prepare the patient for surgery.
• Bulking agents, stool softeners, and suppositories or enemas are used as treatment to reduce pain and straining during bowel movements.
• Surgery to repair of this condition usually is performed by a colorectal surgeon and involves attaching or securing the rectum to the back side (or posterior) part of the inner pelvis.
• Prevention of involves eating a high-fiber diet and drinking plenty of fluids to reduce constipation; avoid straining during bowel movements; treat any long-term diarrhea, constipation, or hemorrhoids.
• The outlook for a patient with this health condition generally is good, and most people recover well after surgery.

The term rectum refers to the lowest 12-15 centimeters of the large intestine (colon). The rectum is located just above the anal canal (the junction is called the anorectal area). Normally, the rectum is securely attached to the pelvis with the help of ligaments and muscles that hold it in place. When these ligaments and muscles weaken, the rectum can slip or fall out of place, or prolapse (also called rectal procidentia).

In the early stages of rectal prolapse, the rectum becomes poorly attached but stays within the body most of the time. This stage is called mucosal prolapse, or partial prolapse, meaning that only the inner lining of the rectum (rectal mucosa) protrudes from the anus. This occurs when the connective tissues within the rectal mucosa loosen and stretch, allowing the tissue to protrude through the anus. When long-term hemorrhoidal disease is the cause, the condition usually does not progress to complete prolapse. Determining if the problem is hemorrhoids or rectal prolapse is important. Hemorrhoids occur commonly, but they rarely cause the condition.

As the rectum becomes more prolapsed, the ligaments and muscles may weaken to the point that a large portion of the rectum protrudes from the body through the anus. This stage is called complete prolapse, or full-thickness rectal prolapse, and is the most commonly recognized stage of the condition. Initially, the rectum may protrude and retract depending on the person's movements and activities. However, if the disease goes untreated, the rectum may protrude more frequently or even permanently.

Rectal prolapse is similar to, but not the same as, a rectocele, a common condition in women, where the rectum falls forward into the backside (or posterior) wall of the vagina, causing a lump inside the vagina.

Another condition commonly considered a form of prolapsed rectum is called internal intussusception. Its effects on the rectum are similar to those of mucosal prolapse or complete rectal prolapse; however, in internal intussusception, the rectum neither protrudes from the body nor enters the anal canal.

• Rectal prolapse is an uncommon disease and primarily affects elderly people.
• The disease is rare among children. Affected children are usually younger than 3 years of age.
• Men develop the condition much less frequently than women do.
• It is extremely rare in the United States.

Rectal prolapse is caused by weakening of the ligaments and muscles that hold the rectum in place. In most people with a prolapsed rectum, the anal sphincter muscle is weak. The exact cause of this weakening is unknown; however, risk factors usually are associated with the following health conditions.

• Age over 40 years
• Long-term constipation
• Long-term diarrhea
• Long-term straining during defecation
• Pregnancy and the stresses of childbirth and vaginal delivery
• Being female
• Women who have had more than five pregnancies (multiparity)
• Previous surgery (particularly pelvic surgery)
• Cystic fibrosis
• Chronic obstructive pulmonary disease (COPD)
• Whooping cough
• Multiple sclerosis
• Dementia
• Stroke
• Pelvic floor dysfunction (such as paradoxical puborectalis contraction, nonrelaxing puborectalis muscle, abnormal perineal descent)
• Pelvic floor anatomic defects (such as rectocele, cystocele, enterocele, deep cul-de-sac)

Long-term hemorrhoidal disease is frequently associated with mucosal prolapse (partial prolapse) that does not progress to complete prolapse of the rectum.

The symptoms of a prolapsed rectum are similar to those of hemorrhoids; however, it originates higher in the body than hemorrhoids do. A patient with a the condition may feel tissue protruding from the anus and experience the following symptoms:

• Pain during bowel movements
• Mucus or blood discharge from the protruding tissue
• Fecal incontinence (inability to control bowel movements)
• Loss of urge to defecate (mostly with larger prolapses)
• Awareness of something protruding upon wiping

Early in the development of this condition, the protrusion may occur during bowel movements and retract afterwards. The protrusion may become more frequent and appear when the patient sneezes or coughs. Eventually, the protruding rectum may need to be manually replaced or may continually protrude.

Patients with internal intussusception in which the rectum is displaced but does not protrude from the body, often experience difficulty with bowel movements and a sense of incomplete bowel movements.

To confirm the presence of a prolapsed rectum, the doctor may ask the person to sit on the toilet and strain. If the rectum does not protrude, the doctor may administer a phosphate enema to confirm the diagnosis. The main condition to distinguish prolapse of the rectum from is protruding or prolapsing hemorrhoids.

A defecogram (a test that evaluates bowel control) may help distinguish between a mucosal prolapse and a complete prolapse of the rectum in a patient.

• Stool softeners, such as sodium docusate (Colace) or calcium docusate (Surfak), may be used to reduce pain and straining during bowel movements.
• Bulk agents, such as psyllium (Metamucil or Fiberall) or methylcellulose (Citrucel) also may be used.

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