What is rectal prolapse?
Rectal prolapse is a condition in which the rectum (the
lower end of the colon, located just above the anus) becomes
stretched out and protrudes out of the anus. Weakness of the
anal sphincter muscle is often associated with rectal prolapse
at this stage, resulting in leakage of stool or mucus. While the
condition occurs in both sexes, it is much more common in women
Why does it occur?
Several factors may contribute to the development of
rectal prolapse. It may come from a lifelong habit of straining
to have bowel movements or as a late consequence of the
childbirth process. Rarely, there may be a genetic
predisposition. It seems to be a part of the aging process in
many patients who experience stretching of the ligaments that
support the rectum inside the pelvis as well as weakening of the
anal sphincter muscle. Sometimes rectal prolapse results from
generalized pelvic floor dysfunction, in association with
urinary incontinence and pelvic organ prolapse as well.
Neurological problems, such as spinal cord transection or spinal
cord disease, can also lead to prolapse. In most cases, however,
no single cause is identified.
Is rectal prolapse the same as hemorrhoids?
Some of the symptoms may be the same: bleeding and/or
tissue that protrudes from the rectum. Rectal prolapse, however,
involves a segment of the bowel located higher up within the
body, while hemorrhoids develop near the anal opening.
How is rectal prolapse diagnosed?
A physician can often diagnose this condition with a careful
history and a complete anorectal examination. To demonstrate the
prolapse, patients may be asked to sit on a commode and "strain"
as if having a bowel movement.
Occasionally, a rectal prolapse may be "hidden" or internal,
making the diagnosis more difficult. In this situation, an x-ray
examination called a videodefecogram may be helpful. This
examination, which takes x-ray pictures while the patient is
having a bowel movement, can also assist the physician in
determining whether surgery may be beneficial and which
operation may be appropriate. Anorectal manometry may also be
used to evaluate the function of the muscles around the rectum
as they relate to having a bowel movement.
How is rectal prolapse treated?
Although constipation and straining may contribute to
the development of rectal prolapse, simply correcting these
problems may not improve the prolapse once it has developed.
There are many different ways to surgically correct rectal
Abdominal or rectal surgery may be suggested. An abdominal
repair may be approached laparoscopically in selected patients.
The decision to recommend an abdominal or rectal surgery takes
into account many factors, including age, physical condition,
extent of prolapse and the results of various tests.
How successful is treatment?
A great majority of patients are completely relieved of
symptoms, or are significantly helped, by the appropriate
procedure. Success depends on many factors, including the status
of a patient's anal sphincter muscle before surgery, whether the
prolapse is internal or external, the overall condition of the
patient. If the anal sphincter muscles have been weakened,
either because of the rectal prolapse or for some other reason,
they have the potential to regain strength after the rectal
prolapse has been corrected. It may take up to a year to
determine the ultimate impact of the surgery on bowel function.
Chronic constipation and straining after surgical correction
should be avoided.