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Rectal Prolapse: Causes, Symptoms, and Treatment

What it is?

The last 12 to 15 centimeters of the large intestine or colon is known as the rectum. Located above the anus, the rectum temporarily stores stool. In a normal situation, the rectum is held in place in the pelvis (lower part of the abdomen) by ligaments and muscles, together with other organs like the bladder (stores urine) and the womb (in females). If these ligaments and muscles become weak for some reason, the rectum starts to move downwards and may even protrude out resulting in a prolapse.

In the initial stage of this condition, the rectum stays inside the body most of the time. But as the condition worsens, the ligaments and the muscles weaken further and a large portion of the rectum can slip out from the anus and if not treated, there could be a permanent protrusion.

Different types of rectal prolapse

Depending upon its severity, rectal prolapse is graded into the following three types:

• Internal prolapse: In such cases, the rectum does not slip out through the anus and remains within the pelvis or anus.
• External prolapse: The rectum protrudes out through the anus.

The causes and risk factors

Rectal prolapse occurs due to weak ligaments and muscles that cannot hold the rectum in place. While the exact cause of the weakening of the muscles and ligaments is not known, a large number of factors can contribute to this condition due to the repeated strain on the pelvic floor and supporting structures of the rectum. The following are some of them.

• Age, especially when above 40 years old
• Injury from childbirth
• Women having multiple pregnancies
• Previous pelvic surgery
• Chronic cough (eg. chronic obstructive lung disease)
• Chronic constipation
• Prolonged diarrhea

Other than these, cystic fibrosis, multiple sclerosis, spinal cord injury may also result in rectal prolapse. Women are found to be more prone to this than men.

What are the signs and symptoms?

The signs and symptoms of rectal prolapse may be similar to that of the hemorrhoids, including a painful bowel movement, discharge of mucus or blood and a sensation of a lump protruding out of the anus. But unlike haemorrhoids, one may also experience improper control of stools (incontinence), need to strain at stools with little output (obstructed defecation). If the prolapse is serious, it may also affect other organs like the bladder and womb (in women).

Diagnosis & treatment of rectal prolapse

The diagnosis of rectal prolapse is by examination. However, in cases where the prolapse is not obvious, one may need a colorectal specialist and specialized X-rays to diagnose this condition. Treatment of the condition depends on the severity of the condition when diagnosed.

Lifestyle changes may be needed to ensure regular bowel movements with dietary modifications, laxatives and doing pelvic floor exercises. If this does not improve or the condition is serious, surgery may be required.

A colorectal surgeon usually performs the surgery. Using modern key-hole (laparoscopic or robotic) surgery, the rectum is secured to the surrounding muscles and ligaments together with a mesh to provide strength for support. The surgeon will advise on the most appropriate surgical option depending on the overall age and health of the patient.