Rectal prolapse

What is rectal prolapse?

Rectal prolapse happens when the rectal wall (part of the large bowel just above the anus) slides out through the anus. It usually happens because the tissues holding the rectum in place (muscles and ligaments) have weakened so it is no longer supported adequately and when the pressure in the abdomen increases – for example when opening the bowels or coughing – the muscles around the back passage aren’t strong enough to hold it in.

If the prolapse is large, stays out most of the time, or is difficult to put back, there is always a risk that it will strangulate. This is a serious problem as the blood supply can be cut off and then the rectum can perforate or the protruding tissue may die.

Symptoms of rectal prolapse

The most obvious symptom is a lump that can be felt outside the back passage. At first, it may only appear after opening the bowels (pooing) but later it may come out when standing or walking or when coughing or sneezing. The lump can usually be pushed back inside but sometimes if it stays outside it can swell and become very painful, this is known as a strangulated prolapse. If this happens an emergency visit to the hospital is necessary.

Other symptoms include a slimy clear or brown discharge (mucus) through the back passage, involuntary loss of stool (poo), or bleeding. It may be difficult to keep clean because of these problems.

Diagnosis of rectal prolapse

The diagnosis of rectal prolapse is usually based on the symptoms and a routine examination of the rectum. To get a more accurate assessment of the size and significance of rectal prolapse, a special x-ray (called an evacuation proctogram) may be performed.

Treatment of a rectal prolapse

Medical treatment for a rectal prolapse aims to improve symptoms and prevent the prolapse from getting worse. This management involves treating any constipation and helping people to avoid straining when pooing.

Increasing the amount of fibre in the diet can make it easier to open the bowels. Eating a high fibre diet (including five portions of fruit/vegetables daily) and drinking six to eight glasses of water each day helps to avoid constipation.

A bulk laxative such as Fybogel may be prescribed to make the stool softer. Sometimes people will be shown how to empty their bowels more effectively to avoid straining. Suppositories or enemas may be prescribed to help empty more effectively without having to strain a lot. People with rectal prolapse should also avoid heavy lifting, get a chronic cough treated, and maintain a healthy weight. These are all things that can reduce the symptoms.

If the rectal prolapse is causing lots of problems and interfering with daily life, then surgery is often advised. The doctor at the hospital clinic will discuss the risks and benefits of surgery based on an examination of the individual and the prolapse. Surgery may be performed through the rectum, through the perineum (the skin between the vagina and the anus), through the abdomen or by using a combination of techniques. The surgeon will discuss these in more detail. The operation will put back the prolapse but in some patients, this cannot improve leakage from the back passage so this may continue.