Rectal Prolapse

Rectal Prolapse occurs when the rectum turns itself inside out and comes out through the anus.

What is rectal prolapse?

A prolapse is a protrusion of a part of the bowel out through the anus. It can occur in childhood or in the elderly.  There are three types of prolapse:

  • incomplete internal prolapse – the rectum does not yet protrude through the anus;
  • mucosal, involving only the inner lining of the rectum; or
  • complete external prolapse of the rectum.

Another type of prolapse seen in women is a rectocoele, which is the rectum protruding into the vagina.

 Occurrence

Women are six times more likely than men to have a rectal prolapse.  In early childhood it usually resolves without surgery.

 Causes

The exact cause of rectal prolapse is unknown.  It is possible that it is due to excessive straining at defaecation, to a weak pelvic floor and anal sphincter muscles, or to a lack of fixation of the lower bowel to adjacent pelvic structures.  Rectal prolapse is six times more common in women than in men, but is not related to childbirth.  It is common in early childhood and usually resolves without surgery in this age group.

Symptoms

The bowel protrudes during defaecation, and at first goes back by itself.  Later it enlarges.  There may be a feeling of incomplete emptying of the rectum.

Diagnosis

Investigation by your General Practitioner may be all that is required.  Sometimes it is necessary for the patient to sit on the toilet and strain to produce a prolapse.  A proctogram may be required if the prolapse is not evident.  If incontinence is a problem anorectal physiology studies may used to assess the function of the sphincter muscle.

Treatment

Mucosal prolapse is treated surgically or, if minimal, by rubber band ligation.  Laxatives can be used in an attempt to reduce straining and bulk up the stool.  If a complete prolapse of the rectum has occurred, surgical intervention is usually required.  Surgery can be carried out either via the abdomen or the anus.  Abdominal operations involve securing the bowel to the lower spine, and may occasionally require removal of a part of the bowel.  Laparoscopic surgery is also utilised to treat this condition.  Operations to correct the prolapse carried out via the anus are less invasive and often all that are required.

Surgery

Success rates for surgery are very good.  Your Colorectal Surgeon will discuss which procedure is appropriate for you.  Some alteration in bowel habit after operation may occur.  This is variable, usually not severe and improves with time.

 Common myths

Childbirth has no bearing on rectal prolapse.

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