Rectal Prolapse

(Mucosal Prolapse; Partial Prolapse; Complete Prolapse; Internal Prolapse)

Definition

The rectum is the end section of the large intestine. When the rectum stretches and falls through the anus, it is called rectal prolapse.

Rectal Prolapse
Rectal prolapse

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Causes  ^

Rectal prolapse is caused by weak muscles and ligaments. These structures hold the rectum in place.

Risk Factors  ^

Children aged 1-3 years and older adults are at higher risk.

  • Risk factors in children include:
    • Cystic fibrosis
    • Previous anal surgery
    • Malnutrition
    • Straining during bowel movements
    • Infections
  • Risk factors in adults include:
    • Straining during bowel movements
    • Pregnancy and the stress of childbirth
    • Weakness of pelvic floor muscles due to aging
    • Hemorrhoids

Symptoms  ^

Symptoms may include:

  • Difficulty controlling bowel movements
  • Bleeding or mucous from the anus
  • Constipation
  • Feeling of incomplete bowel movements
  • Loss of urge to defecate
  • Anal pain or itching
  • Tissue that sticks out of the anus
  • Pain during bowel movements

Diagnosis  ^

You will be asked about your symptoms and medical history. A physical exam will be done. Your anus and rectum will be examined.

Images may be taken of your body structures. This can be done with:

  • Defecography—series of x-rays of the rectum and anus taken during a bowel movement
  • Colonoscopy —visual exam of the rectum and colon (large intestine) using a flexible tube with a tiny camera on the end

An anorectal manometry may also be done to measure the strength of the anal sphincter muscles, sensation in the rectum, and the reflexes needed for normal bowel movement.

Treatment  ^

Prolapse in children tends to go away on its own. In adults, gentle pressure to the rectum can sometimes push the rectum back into place. The sooner the condition is treated, the better the outcome. Talk with your doctor about the best plan for you.

Medications

Certain medications may help to reduce pain and straining during bowel movements. Your doctor may recommend stool softeners and bulk agents.

Surgery

In some cases, surgery may be needed. Surgeries used to treat rectal prolapse include:

  • Laparoscopic rectopexy—A laparoscope (a tiny camera) is placed through a small incision in the abdomen. The rectum is secured in place with stitches.
  • Perineal proctectomy—An incision will be made in the rectum. Tissue that is sticking out of the anus is removed.

Prevention  ^

To help reduce your chance of rectal prolapse:

  • Eat a healthy diet that is high in fiber.
  • Exercise regularly.
  • To train your bowels, create a routine. For example, try to go to the bathroom after lunch each day.
  • Do not rush when moving your bowels.
  • If you feel the urge to move your bowels, go to the bathroom.
RESOURCES:

American Gastroenterological Association
http://www.gastro.org

American Society of Colon and Rectal Surgeons
https://www.fascrs.org

CANADIAN RESOURCES:

Canadian Society of Intestinal Research
http://www.badgut.com

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Constipation in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 9, 2014. Accessed December 18, 2014.

Constipation in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 3, 2014. Accessed December 18, 2014.

Last reviewed December 2015 by Daus Mahnke, MD