Rectal Prolapse

What is rectal prolapse?

Rectal prolapse occurs when the rectum, which is the last portion of the large intestine, protrudes or falls out of the anus. The condition can range in severity and may involve only a portion of the rectal lining (mucosa) or the entire rectum.

Rectal prolapse is different from a rectocoele, which is a condition where the front wall of the rectum protrudes into the vaginal space.

What causes rectal prolapse?

The exact cause of prolapse is not always clear, but several factors may contribute to its development:

 

1.   Weakness of pelvic floor muscles

·      Weakness in the muscles and ligaments that support the rectum and anus can contribute to prolapse.

 

2.   Chronic constipation

·      Straining during bowel movements can weaken the pelvic floor and contribute to prolapse.

3.   Aging

 

4.   Childbirth

·      Women who have had multiple vaginal deliveries may be at an increased risk.

 

5.   Neurological disorders

·      Conditions that affect nerve function, such as multiple sclerosis or spinal cord injury, may increase the risk.

 

6.   Chronic cough or respiratory issues

What are the symptoms of rectal prolapse?

The symptoms of rectal prolapse can vary depending on the severity of the condition.

  • Visible protrusion

  • Pain or discomfort, especially during bowel movements or while rectum is protruding.

  • Changes in bowel habits are common. Some individuals may experience constipation, while others have difficulty controlling bowel movements.

  • Bleeding from the rectum can occur, particularly if the exposed rectal tissue become irritated or injured.

  • Difficulty in fully emptying the bowels during bowel movements.

How is rectal prolapse diagnosed?

The diagnosis of rectal prolapse typically involves a combination of medial history, physical examination and in some cases imaging studies.

Physical examination

  • The healthcare provider will inspect the anus and may perform a digital rectal examination. During the examination, the provider will assess the extent of the prolapse, characteristics of tissue involved, and any associated symptoms.

Dynamic evaluation

  • The healthcare provider may conduct dynamic evaluation, which involves observing the rectum during certain activities that may trigger or worsen the prolapse. This may include asking the individual to strain as if having a bowel movement. 

Colonoscopy or sigmoidoscopy

  • A colonoscopy or sigmoidoscopy may be recommended to visualise the entire colon and rectum. This allows the health care professional to rule out other potential causes of symptoms such as colorectal polyps or inflammatory bowel disease.

Defaecography

  • Defaecating proctography is an imaging study that involved taking X-ray images while the individual is having a bowel movement.

  • This allows healthcare providers to observe the rectum’s function and assess the extent of rectal prolapse.

Anorectal manometry

  • This is a test that measures the pressure and function of muscles in the rectum and anus. It provides information about muscle coordination and function.

How is rectal prolapse treated?

The treatment of rectal prolapse depends on the severity of the condition, the individual’s overall health and their preferences. Treatment options are broadly divided into conservative measures to surgical intervention.

Conservative or Non-Surgical Treatment

  1. Dietary and Lifestyle Modifications: Increasing dietary fiber and fluid intake can help prevent constipation.

  2. Pelvic floor Exercises: Strengthening the pelvic floor muscles through exercises may be recommended to provide better support to the rectum.

  3. Biofeedback Therapy: Biofeedback is a technique that helps individuals gain awareness and control over certain bodily functions, including pelvic floor muscles. It can be beneficial for improving muscle function and coordination. 

  4. Medications: Stool softeners or laxatives may be prescribed to manage constipation and reduce straining during bowel movements.

Surgical Treatment:

  1. Rectopexy: Rectopexy is a surgical procedure in which the rectum is surgically repositioned and secured to the back of the pelvis.

  2. Resection with or without Colostomy: In cases of severe rectal prolapse or when other treatments are not effective, a segment of rectum may be removed. In some cases, a colostomy (a surgical opening in the abdomen for stool drainage) may be created.

  3. Delorme’s Procedure: Delorme’s procedure involves removing the redundant rectal lining and reinforcing the remaining rectum.