Rectal Prolapse: Causes, Symptoms, and Modern Treatment Options

Rectal prolapse is a distressing condition where the rectum protrudes through the anus. This issue often causes discomfort, embarrassment, and challenges with daily activities. Factors like age, weakened pelvic muscles, chronic constipation, or childbirth can contribute to this condition. 

In this blog, we’ll delve into the causes, symptoms, treatment options, and lifestyle changes that can help manage rectal prolapse effectively.

What is Rectal Prolapse?

The rectum, the final part of the large intestine before the anus, is where faeces gathers before exiting the body. Faecal arrival in the rectum signals the urge to defecate, with muscles aiding expulsion through the anus. 

Rectal prolapse involves the rectum shifting downwards into the anal canal, sometimes protruding outside. Healthcare terms this as prolapse, where a body part descends from its original position due to weakened muscles. Muscle weakening, common with ageing, can be hastened by factors like childbirth, chronic constipation, or diarrhoea, impacting the rectum’s stability.

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What are the Types of Rectal Prolapse?

There are three classifications of rectal prolapse, distinguished by the extent of rectal movement:

1. Internal Prolapse: The rectum begins to descend but has not yet protruded through the anus.
2. Partial Prolapse: Only a section of the rectum protrudes through the anus.
3. Complete Prolapse: The entire rectum protrudes outward through the anus.

What are the Symptoms of Rectal Prolapse?

Rectal prolapse symptoms start slowly with a bulge sensation around the anus, resembling sitting on a ball. Over time, a reddish bulge may extend from the anus, visible with a mirror.

Key Symptoms to be Aware of include:

• Rectal protrusion during bowel movements, which can usually be manually repositioned
• Activities like walking or exercise may exacerbate rectal protrusion
• Bleeding from the rectum’s inner lining
• Potential loss of bowel control, leading to issues with both solid and liquid waste and gas expulsion

Moreover, rectal prolapse often coincides with chronic constipation (in 30-67% of cases) and diarrhoea (in about 15%).

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What are the Causes of Rectal Prolapse?

Muscular weakness supporting the rectum can result in rectal prolapse, which can be influenced by various factors, such as:

• Ageing.
• Pregnancy and childbirth.
• Prior pelvic injury or surgery.
• Persistent constipation or diarrhoea.
• Infections caused by intestinal parasites.
• Chronic coughing or sneezing.
• Damage to the spinal cord or nerves.
• Cystic fibrosis.

What are the Complications of Rectal Prolapse?

Rectal prolapse can potentially result in serious complications, such as:

1. Development of Ulcers: Ulcers within the rectum can lead to symptoms like bleeding and pain.
2. Sphincter Damage: The sphincter, a circular muscle that controls the opening and closing of the anus, may be harmed, affecting its function.
3. Bowel Control Issues: Rectal prolapse can contribute to difficulties in bowel control, potentially resulting in faecal incontinence.
4. Gangrene: Without treatment, rectal prolapse can cause the rectum to become strangulated, cutting off its blood supply and leading to tissue death, a condition known as gangrene. This situation necessitates immediate medical intervention, typically through surgery

How is Rectal Prolapse Diagnosed?

Your healthcare provider will review your medical history and conduct a rectal exam. They might ask you to contract your muscles. Additional tests may be used for diagnosis, like:

• Digital Rectal Exam: A hands-on examination using lubricated gloves.
• Defecography: An imaging study capturing muscle activity during defecation, often utilising X-ray or MRI technology.
• Anorectal Manometry: This test evaluates the strength and integrity of your anal sphincters.
• Lower GI Series (Barium Enema): A sequence of X-ray images of your lower gastrointestinal tract.
• Colonoscopy: A procedure to inspect the large intestine’s interior using a flexible scope.
• Electromyography (EMG): This diagnostic test assesses nerve and muscle function in the anal area.

What is the Treatment for Rectal Prolapse?

Rectal prolapse treatment options depend on symptom severity and impact on quality of life. The treatment is also impacted by:

• Delaying Treatment: Mild cases may be managed without immediate surgery if symptoms are tolerable.
• Non-surgical Management: Softening stools can reduce straining and potentially resolve mild prolapse.

For definitive treatment, these surgical options are often necessary:

Abdominal Approach

Involves making an incision in the abdomen to reposition the rectum (abdominal rectopexy), sometimes done laparoscopically.

Rectal (Perineal) Repair

• Altemeier Procedure: Removes protruding rectum and reconnects.
• Delorme Procedure: Suitable for shorter prolapses, involves rectal lining removal and muscle folding.

These surgeries are recommended for severe cases or when laparoscopic procedures are unsuitable due to constipation.

How can You Prevent Rectal Prolapse?

Preventing rectal prolapse is challenging, but you can lower your risk by prioritizing intestinal health. To minimize constipation:

• Incorporate high-fibre foods into your daily meals, such as fruits, vegetables, bran, and beans.
• Limit intake of processed foods.
• Stay hydrated by drinking ample water and fluids daily.
• Engage in regular exercise most days of the week.
• Practice stress management through meditation or relaxation techniques.

Conclusion

Rectal prolapse is a challenging condition that requires prompt medical attention. Treatment options vary based on severity, with surgery often providing the most effective long-term solution. Early intervention is key to restoring quality of life. It is always advisable to seek medical help from an experienced general surgeon. Timely care and help can ensure an appropriate diagnosis and treatment of your condition. 

At the CK Birla Hospital, we ensure patients get holistic medical support which includes treatment in a compassionate environment. This patient-centric approach not only helps patients heal better but also ensures they are aware of the preventive measures as well. In case you need to consult a general surgeon, reach out to us, or book a direct appointment with gastroenterologist at the CK Birla Hospital. 

FAQs

Can Rectal Prolapse Resolve on its Own?

Rectal prolapse rarely resolves on its own and typically requires medical intervention such as surgery. Early diagnosis and treatment are essential for managing rectal prolapse effectively.

Is Rectal Prolapse Common in Children?

Rectal prolapse is uncommon in children but can occur, especially in those under 4 years old. It’s often associated with underlying conditions like cystic fibrosis or chronic constipation.

Who is at Risk of Developing Rectal Prolapse?

Risk factors include elderly individuals, women who have given birth multiple times, chronic constipation sufferers, and those with connective tissue disorders.

When should I See a Doctor for Rectal Prolapse?

Seek medical advice if you notice symptoms of rectal prolapse, such as a protrusion from the anus, difficulty controlling bowel movements, or persistent rectal discomfort.