Rectal Prolapse: Causes, Symptoms, Treatment, and Recovery Guide

What Is Rectal Prolapse?

Rectal prolapse is a condition where you will see your rectum, the last part of your large intestine, coming out or slipping out of the anus. It means you will see your rectum outside your body, like a red mass protruding out.

Rectal prolapse in adults can be of partial rectal prolapse (only part of the rectum protrudes out) or complete rectal prolapse (entire rectum slips out of its usual place).

The rectum is the place where your stool gets ready to leave your body. When the stool reaches the rectum, a group of muscles contracts to push it through the anus. In the case of rectal prolapse, the rectum follows a similar pattern, forcing it to protrude through the anus.

Prolapse is the term that describes any body part that has slipped down from its original position. It usually means that the muscles supporting the part have weakened.

What Causes Rectal Prolapse?

Rectal prolapse occurs when the muscles that support the rectum become weak.

Rectal prolapse causes include the following -

• Aging.

• Chronic constipation.

• Strain during bowel movements.

• Diarrhea.

• Childbirth (particularly after multiple deliveries).

• Any injuries to the pelvic region.

• Chronic cough.

• Pelvic floor muscle weakening.

• Sneezing.

• Injury to the spinal cord.

• Weakening of the anal sphincter.

• Any illness that constantly raises the pressure in your belly region, such as benign prostatic hypertrophy (enlarged prostate) or chronic obstructive pulmonary disease (a lung condition that restricts airflow and makes breathing difficult).

• Certain genetic conditions can inhibit the normal functioning of the abdominal nerves, causing constant strain when moving stools and leading to rectal prolapse.

What Does Rectal Prolapse Look Like?

Rectal prolapse can look different for each person. It includes -

• Internal Prolapse: The rectum slides down inside but does not come out of the anus.

• Mucosal Prolapse: Only the rectum’s inner lining turns inside out and starts to stick out of the anus.

• External Prolapse: The whole rectum comes out through the anus.

At first, this might only happen when you poop, but over time, it can stay out all the time.

What Are the Symptoms of Rectal Prolapse?

Rectal prolapse symptoms include the following-

• A red lump or mass pops out of the anus.

• Fecal incontinence (inability to control bowel movements).

• Constipation.

• Loose stools.

• Feeling of incomplete bowel emptying.

• Mucus, blood, or stool leakage.

• Itching or pain in the anal region.

How Is Rectal Prolapse Diagnosed?

Diagnosis of rectal prolapse depends on your medical history and physical examination by a physician. The following tests are used to diagnose rectal prolapse and rule out other conditions.

1. Digital Rectal Exam (DRE): The doctor inserts a lubricated, gloved finger into the anus to assess whether the rectum is normal or abnormal.

2. Defecography: This is an X-ray or MRI (magnetic resonance imaging) test that shows how your rectum and muscles work while you are pooping, to see if anything is dropping or not moving correctly.

3. Colonoscopy: A small, slender tube with a camera is inserted into your large intestine to look inside for any problems like hemorrhoids, polyps, or colon cancer.

4. Electromyography (EMG): This test assesses the nerves and muscles surrounding your anus to determine if nerve damage is causing weakness or poor coordination.

5. Anorectal Manometry: This test determines the strength and tightness of the anal muscles (sphincters) to check if they can hold stool properly. A thin tube with a small balloon at the end is inserted into the anus and into the rectum, and then it is blown up to check the elasticity of the anal sphincter.

6. Barium Enema: During this test, a small, flexible tube is inserted into the rectum, and a liquid called barium is injected to fill the colon. The barium coats the lower gastrointestinal tract, making it clearly visible in X-rays. A series of X-rays is then taken to check and assess the shape and movement of your rectum and colon.

How Do You Fix Rectal Prolapse?

Rectal prolapse treatment often requires rectal prolapse surgery, with the type depending on severity and the individual's overall health status.

In healthy individuals, rectopexy, a type of surgery that is done through the abdomen to fix the prolapse, is preferred. However, some may not be suitable candidates for the abdominal approach; in those cases, the rectal approach is used to correct the condition.

Abdominal Approach (Rectopexy):

This surgery helps to position your rectum in its usual place. The physician will attach the rectum to the back wall of the pelvis using permanent stitches. Sometimes, a mesh is also used to support it. These will keep your rectum in place for long enough for scar tissue to form, which will then maintain its position.

Rectopexy can be done in two ways:

1. Open Abdominal Surgery: In this approach, the rectum is pushed back into place through an opening made in the abdominal cavity to assess the organs. Then, the rectum is secured to the sacrum, or back wall of the pelvis, with stitches or a mesh sling.

2. Laparoscopic Surgery: In this method, the physician makes many tiny incisions in the abdomen. The physician then inserts specialized surgical equipment and a small camera into the cuts to treat the rectal prolapse.

Rectal Approach (Perineal):

The rectal approach is considered when you are not suitable for the abdominal approach. Unlike the abdominal approach, the rectal approach does not require general anesthesia. This method helps to treat minor rectal prolapse. This can be done in two ways -

1. Altemiere Approach: In this approach, the prolapsed rectum is pulled out through the anus and removed. The remaining part of the rectum is connected to the colon, and it acts as a rectum.

2. Delorme Approach: This method is used when you have a small external rectal prolapse. The mucosal layer lining the rectum is removed, and the muscular layer is folded and stitched to the anal canal.

Rectal prolapse recovery time varies depending on the surgery type and the health status of the individual. It generally takes four to six weeks for recovery after rectopexy and months to heal completely.

How Can I Prevent Rectal Prolapse?

You can prevent rectal relapse by treating the conditions that cause it promptly.

• Consult a doctor if you have chronic constipation or some other condition like pelvic floor dysfunction that puts constant strain on your pelvic muscles.

• Making lifestyle changes and taking medications as prescribed by your doctor can help you manage it.

• Engage in exercises like the Kegel exercise that make your pelvic muscles stronger and fitter. They help prevent fecal incontinence and pelvic organ prolapse.

Conclusion:

Rectal prolapse is a condition that occurs over time due to weakening of the pelvic floor muscles or the muscles that hold the rectum in its place. The risk factors include chronic constipation and aging. Engaging in regular exercises that focus on pelvic floor muscles keeps your pelvic organs in place and fosters overall health.

To learn more about rectal prolapse and treatment options for adults, you can reach out to doctors at iCliniq anytime to get expert guidance.

Key Takeaways:

• Rectal prolapse occurs due to weakening of the muscles that support the rectum in its usual place.

• Rectal prolapse is more common in women and occurs in people aged 50 and above.

• Rectal prolapse can be prevented by treating the conditions that cause it.

• If you have any concerns regarding rectal prolapse, you can book a consultation with a gastrologist at iCliniq to get clarity.