What Is Rectal Prolapse? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Rectal prolapse occurs when part or all of the rectum slides out of place and sticks out of the anus, turning the rectum inside out.

The rectum is the final section of the large intestine before the anus (the opening through which stool passes out of the body).

Rectal prolapse is an uncomfortable condition that usually requires surgery to fix.

There’s no single definitive cause of rectal prolapse, although a number of known factors can increase your risk of developing this condition.

• Chronic constipation (difficult bowel movements that happen less than three times in a week)
• Chronic diarrhea (bowel movements are watery or runny, and happen more than three times a day on a regular basis)
• History of straining during bowel movements
• Weak muscles in the pelvic area
• Being of older age (muscles in the area weaken with age)
• Previous injury in the anal or pelvic area
• Nerve damage (may be due to pregnancy, difficult vaginal birth, paralysis of the anal sphincter, spinal injury, or back injury)

Or they may also administer or order the following tests:

• Defecogram X-rays taken during a bowel movement examine muscle movement.
• Anorectal manometry A thin tube is used to measure the strength of the sphincter.
• Colonoscopy A tube with a camera is used to examine the colon.
• Anal sphincter electromyography (EMG) An electrode measures sphincter muscle activity.
• MRI This test can help assess organs used during a bowel movement.

Prognosis of Rectal Prolapse

Prognosis tends to be good. If surgery is needed, it has a high success rate and usually cures the prolapse.

Treatment for rectal prolapse depends on the severity of your symptoms. Sometimes prolapses resolve on their own. Initially your healthcare provider might work with you to manage the constipation that might be causing the prolapse through adding fiber to your diet and keeping hydrated. Your doctor might work with you to avoid straining during bowel movements. Kegel exercises to strengthen the pelvic muscles might also be advised.

If none of these strategies help, surgery is usually required — especially if you’re experiencing recurrent episodes.

Surgery can keep rectal prolapse from happening again. Two types of surgical procedures are typically used to treat rectal prolapse:

• Abdominal repair Surgery to fix rectal prolapse is usually done through the belly. Abdominal surgery for rectal prolapse usually involves making a small cut in the lower abdomen. The surgeon will then pull the rectum upward and attach it to a small bone in the lower back so that it can’t slip out again.
• Rectal repair In this type of surgery, the surgeon works through the anus rather than making an incision in the abdomen. This surgery is often performed on older patients or those with more medical problems.

The two most common rectal procedures are:

• Altemeier procedure In this procedure, the surgeon cuts off or removes a portion of the rectum that extends outside the anus. The remaining rectum is pushed back inside the body and attached to the inside of the anus.
• Delorme procedure In this procedure, the inner lining of the fallen rectum is removed. The outer lining is then folded and sewn back so that it no longer protrudes.

Prevention of Rectal Prolapse

To prevent rectal prolapse, avoid straining during bowel movements.

• Drink plenty of water
• Eat fruits, vegetables, and other foods that are high in fiber
• Exercise regularly
• Use laxatives but only as directed by your healthcare provider because of the potential risks of chronic use
• Consider bowel training, which involves having a bowel movement at the same time each day

• Ulcers in the rectum. These can lead to bleeding.
• A prolapse that can’t be pushed back into the rectum. Emergency treatment is necessary in this case because the blood supply to the prolapse will be cut off, resulting in pain.
• Damage to the muscles and nerves in the sphincter. These can worsen fecal incontinence.

The website for the American Society of Colon and Rectal Surgeons provides a detailed and thorough guide for this condition.

Additional reporting by Abbi Libers and Carlene Bauer.