Rectal prolapse is a condition in which the rectum, the last part of the large bowel, slides down and comes out through the anus. It is uncomfortable and often embarrassing, so many people delay seeking help. It can be treated effectively. This article explains the symptoms and causes and compares the treatment options.
What is rectal prolapse?
In a full-thickness prolapse the whole wall of the rectum comes out. At first it may appear only when you strain and go back by itself. Later it may come out when you stand or walk and need to be pushed back by hand. Read more on the rectal prolapse page.
Symptoms
- A red, moist lump or tissue coming out of the anus
- Mucus or blood on the underwear
- A feeling that the bowel has not emptied
- Constipation, or leaking of stool
- Discomfort when sitting
Rectal prolapse or piles?
The two are often confused because both cause a lump at the anus. Haemorrhoids (piles) are swollen blood vessels, while prolapse is the bowel wall itself coming out, usually seen as circular folds. The treatments are different, so an examination by a specialist is important.
Causes and risk factors
- Long-standing constipation and straining
- Weak pelvic floor muscles, more common with age and after childbirth
- Long-lasting diarrhoea
- Nerve or spinal problems in some patients
It is most common in older women but can occur in men and at any age.
How it is diagnosed
The diagnosis is usually made by examination, sometimes by asking you to strain. A colonoscopy may be advised to check the rest of the bowel, and some patients need tests of bowel and pelvic floor function.
Can it be treated without surgery?
Treating constipation with fibre, fluids and laxatives eases symptoms and is important for everyone. In adults, however, a full-thickness prolapse does not go away without an operation.
Surgical options
Operations through the abdomen (rectopexy)
The rectum is lifted and fixed to the bone at the back of the pelvis, often with a mesh. This is frequently done by laparoscopic (keyhole) surgery through small cuts. In patients with severe constipation, part of the colon may be removed at the same time. These operations generally have a lower chance of the prolapse returning.
Operations from below (perineal procedures)
The prolapse is repaired through the anus, without opening the abdomen. These operations are shorter and gentler on the body, so they are often chosen for older or frail patients, though the prolapse is somewhat more likely to return.
How the choice is made
Your surgeon considers your age, general health, bowel function, earlier operations and the size of the prolapse, and discusses the options with you.
Recovery and preventing recurrence
- After keyhole surgery most patients are walking the next day and go home within a few days
- Avoid straining: eat fibre, drink enough water and use a laxative if advised
- Avoid heavy lifting for several weeks
- Pelvic floor exercises may help bowel control
When to seek urgent help
Go to hospital straight away if the prolapse cannot be pushed back, becomes very painful, or turns dark in colour.
Frequently asked questions
Will my bowel control improve after surgery?
Many patients notice better control once the prolapse is corrected, although improvement can take some months.
Can the prolapse come back?
It can, with any operation. Avoiding constipation and straining lowers the chance.
Is rectal prolapse cancer?
No. It is not cancer and does not turn into cancer, but the bowel should still be checked if you have bleeding.
For an assessment, request an appointment with Dr. Fayem Chowdhury Sony.
This article is for general awareness and does not replace a consultation with a doctor.