When a part of the rectum protrudes from the anus, rectal prolapse is. The rectum is the last component of the large intestine which is where the feces are deposited prior to passage.
Prolapse happens when the rectum inside the body is unattached and comes out through the anus, essentially turning inside out.
Rectal prolapse is a fairly rare disease which is estimated by the American Society of Colon and Rectal Surgeons to affect fewer than 3 of every 100,000 individuals.
Fast facts on rectal prolapse:
- A rectal prolapse tends to become noticeable gradually over time.
- Often it is associated with weak muscles in the pelvis.
- There can be complications if it is not treated promptly and properly.
- Treatment will depend on age, general health, and the cause of the prolapse.
There are three types of rectal prolapse:
- Full-thickness: The rectum wall’s entire thickness sticks out from the anus. It is the most prevalent form of rectal prolapse. Protrusion may be partial or complete.
- Mucosal: Just the anal covering (called the mucosa) sticks out of the anal.
- Internal: The rectum folds in on itself, but the anus does not stick out.
Causes, risk factors, and related conditions
There are a number of risk factors and causes associated with rectal prolapse, but doctors don’t completely understand why more people are having it.
A number of items can cause that, including:
- constipation or chronic straining
- diarrhea — present in around 15 percent of people
- conditions that make a person cough a lot
There are also some neurological conditions that affect the nerves associated with rectal prolapse:
- multiple sclerosis
- lumbar disc disease
- spinal tumors
- injury to the lower back or pelvis
Rectal prolapse is more common in adults than children, particularly in women 50 years of age or older who are six times more likely to be affected than men.
Most women with rectal prolapse are in their 60s, and most men are at or younger than 40 years old.
For older women, rectal prolapse frequently occurs concurrently with a prolapse of the uterus or of a bladder. It is due to general weakening of the muscles in the pelvic floor.
Symptoms and complications
At first, when they have a bowel movement, the person may just feel a lump or swelling coming out of their anuses.
The person may initially be able to force the rectal prolapse back in. Nonetheless, the prolapse is likely to protrude permanently over time, and a individual may not be able to suppress the prolapse.
A rectal prolapse may occur as time goes on when a person is coughing, sneezing, or standing up. Some people who have rectal prolapse described it as “sitting on a stone.”
Many people may experience an internal prolapse of the rectal, which is special since the prolapse does not protrude. However, during a bowel movement the individual can feel as though they haven’t passed anything.
Many Rectal Prolapse signs include:
- difficulty controlling bowel movements, which occurs in around 50 to 75 percent of cases
- bright red blood coming out of the rectum
- constipation, present in about 25 to 50 percent of people who have a rectal prolapse
- Strangulated prolapse: This occurs when part of rectum becomes trapped and cuts off the blood supply, causing tissue to die. This can develop gangrene, and the area will turn black and drop off. It is rare and requires surgery.
- Solitary rectal ulcer syndrome: Present in mucosal prolapse, ulcers can develop on the part of the rectum sticking out. This complication often requires surgery.
- Recurring prolapse: People who have surgery for rectal prolapse may have another prolapse at some point in the future.
When to see a doctor
While a rectal prolapse is not always described as a medical emergency, it can be painful, embarrassing and have a serious adverse effect on the mental and physical life of the person.
This is also important that someone who has encountered any signs or symptoms of rectal prolapse will see a doctor as soon as possible.
The longer a person holds off seeking rectal prolapse care the greater risk of chronic issues such as incontinence and damage to the nerves.
To diagnose a rectal prolapse, the doctor should look at the medical history of the person, ask them about their symptoms and conduct a physical test.
A physical test includes the doctor inserting a gloved, lubricated finger into the rectum. Although this may be unpleasant and potentially humiliating, it should not be painful and for accurate diagnosis is very important.
Further testing may be appropriate to explain the diagnosis or to rule out certain mechanisms, including:
- Proctography: A type of X-ray that shows the rectum and anal canal during a bowel movement.
- Colonoscopy: A long, flexible, tube-like camera called a colonoscope is inserted to take a closer look at the large intestine and rectum.
- Endoanal ultrasound: A thin ultrasound probe looks at the muscles used to control the bowels
Treatment and management options
It’s essential to treat constipation first. This may be done by eating plenty of high-fiber foods, such as berries, vegetables and whole grains.
It may also be advised to stock laxatives, which help a person get a bowel movement without straining, and to drink plenty of water.
If that doesn’t work then surgery could be recommended. The type of surgical procedure may depend on a variety of factors:
- type of prolapse
- the person’s age
- other medical problems
- whether the person is constipated or not
There are two general types of surgery for rectal prolapse:
- Abdominal: Entry through the belly through a cut or several cuts in the abdominal wall. Often used for full-thickness prolapse.
- Perineal: Involves cutting out the full thickness segment of the prolapsing rectum. Suitable for people who cannot have a general anesthetic.
Rectal prolapse or hemorrhoids?
One can confuse rectal prolapse with hemorrhoids, also known as piles. This is because both diseases have similar symptoms which affect the last part of the bowel.
Although rectal prolapse affects the rectal wall, hemorrhoids also affect the anal canal’s blood vessels. The two conditions need different care, so having the right diagnosis is crucial.
There are some lifestyle changes people can make to try and avoid rectal prolapse, including:
- eating plenty of fiber
- drinking plenty of water
- exercising regularly
- avoiding excessive straining during a bowel movement
Most people are making complete recovery after rectal prolapse treatment and live a normal life.
Proper rehabilitation, however, is important and how long it will take depends on the type of treatment.
Usually, people who have had surgery spend 3 to 5 days in the hospital after the surgery, and most have a full recovery within 3 months. Individuals can stop straining and heavy lifting for at least 6 months after having undergoed surgery for a rectal prolapse.