Patient Information
Rectal prolapse
What is a rectal prolapse?
A prolapse is a protrusion of some part of the bowel through and outside the anus. It may occur in childhood or in the elderly. There are three types of prolapse:
- Incomplete (internal) prolapse: the rectum is not yet protruding through the anus.
- Mucosal prolapse involving only the inner lining of the rectum.
- Complete (external) prolapse of the rectum.
Causes:
The exact cause is not known. Possible reasons are excessive straining while passing a bowel motion, a weak pelvic floor and anal sphincter muscles, or a lack of fixation of the lower bowel (rectum) to adjacent pelvic structures. It is much more common in women and not related to childbirth.
Symptoms:
Prolapse of the bowel may occur during the passing of a bowel motion which at first goes back by itself. It may then require a reduction into the anus by hand. There may be discomfort, bleeding and the passage of mucus. Incontinence of faeces or poor control of the bowel is a very common symptom. This becomes more severe as the prolapse increases in size. A feeling of constipation or incomplete emptying of the rectum may be an associated symptom.
Investigation
Examination by your surgeon is often all that is required after asking the patient to strain. Sometimes it is necessary for the patient to sit on the toilet and strain to produce a prolapse. A defecating proctogram x-ray may be useful if a prolapse is suspected but the patient cannot induce it. If incontinence has been a problem there are tests of sphincter muscle function which can be performed which include anal manometry testing and an endoanal ultrasound scan. These are both painless procedures and may be done in a clinic.
Treatment
Mucosal prolapse is treated either by rubber banding or by surgery. An incomplete prolapse of the rectum in adults may be treated with bulk laxatives in an attempt to reduce straining with defaecation. If a complete prolapse of the rectum occurs then surgery is usually required. There are several operations available which may be performed either via the abdomen or the anus.
