Rectal Prolapse

Rectal prolapse can look and feel like haemorrhoids, but one major difference is that it doesn’t clear up by itself. While it isn’t serious, it can potentially lead to complications and cause discomfort.

In this blog, you’ll discover what it is, what causes it, and how it can be treated effectively.

What is rectal prolapse?

Rectal prolapse is a medical condition where the rectum, which is the bottom part of the colon just above the anus, becomes overstretched and protrudes out of the anus. In some cases, only the rectal lining may be affected, resulting in a rectal mucosal prolapse. This situation is somewhat like prolapsing haemorrhoids. However, if the entire rectal/bowel wall, including both the inner mucosa and outer muscle layer, prolapses, it is referred to as a full-thickness rectal prolapse or complete rectal prolapse.

Sometimes, the prolapse can occur internally, causing the rectum to collapse within itself. In this case, no visible prolapse may be seen coming out through the anus. This condition is known as an internal intussusception and diagnosing it can be more challenging. It may require specialised x-rays or scans to identify the issue.

While both men and women can experience the condition, it predominantly occurs in women. The condition is more prevalent among older individuals, but it can sometimes affect young children too.

Identifying what causes rectal prolapse

Various factors can contribute to rectal prolapse, and several risk factors are associated with the condition. Chronic constipation, which may result from a lifelong habit of straining during bowel movements, is one such factor. Excessive straining due to conditions like prostatic hypertrophy, pregnancy, or a severe or chronic cough can also increase the likelihood of it happening. A weak pelvic floor following childbirth or surgery is another risk factor.

In some cases, genetic predisposition plays a role, with rectal prolapse in children being associated with cystic fibrosis, Ehlers-Danlos syndrome, and Hirschsprung’s disease. Aging can also contribute to the condition as ligaments supporting the rectum inside the pelvis stretch, and the anal sphincter muscle weakens.

Additionally, pelvic floor dysfunction, often in conjunction with pelvic organ prolapse and urinary incontinence, can be a contributing factor. However, in most cases, no single cause can be pinpointed.

Approaches to treatment

Rectal prolapse may not cause immediate problems, and some individuals can manage it at home by manually pushing the rectum back into place. However, prolapse tends to worsen over time. Potential complications include faecal incontinence, affecting around 50-75% of patients, and constipation due to rectum bunching, and muscle coordination issues. Rectal ulcers and painful sores, which can lead to anaemia, may also develop due to friction and mucous lining exposure. In rare cases, an incarcerated rectum may become stuck outside the anus, risking strangulation, tissue death, and rectum decay (gangrene).

Various surgical methods exist for rectal prolapse treatment, and the chosen procedure depends on the individual’s specific condition. Generally, healthy adults undergo a rectopexy, a surgery to repair the rectum through the abdomen. However, for those unsuitable for abdominal surgery, an alternative option is rectal surgery.

If you are concerned that you have a rectal prolapse or would like a confirmed diagnosis, book an appointment today. Mr Michael Stellakis can discuss with you the most appropriate surgical or non-surgical treatments and help you choose the best option.