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Rectal Prolapse

WHAT IS RECTAL PROLAPSE?

Rectal prolapse is the sliding out of either the superficial lining or the full-thickness wall of the rectum through the anal opening. This is typically the result of chronic constipation or other conditions that increase intra-abdominal pressure such as pregnancy, chronic cough, or prostate issues. The supportive tissues that suspend the rectum become lax.

Commonly, this presents with rectal tissue that extrudes out of the anus at the time of defecation. The tissue may spontaneously retract back into the anal canal or may require manual pressure to push the rectum back into the anal canal.   

At Loma Linda University Health, our whole person care approach is used to treat all conditions, including rectal prolapse.

WHAT ARE THE SYMPTOMS OF RECTAL PROLAPSE?

Symptoms of rectal prolapse include:

  • The sliding out of either the superficial lining or the full-thickness wall of the rectum through the anal opening.
  • Rectal tissue that comes out of the anus at the time of defecation
  • The feeling that a “donut” of tissue is coming out

WHAT CAUSES RECTAL PROLAPSE?

Rectal prolapse is commonly caused by chronic constipation or other conditions that increase intra-abdominal pressure such as pregnancy, chronic cough, or prostate issues.

HOW IS RECTAL PROLAPSE DIAGNOSED?

Rectal prolapse may be diagnosed during a medical history and a rectal exam. Other tests may be done to determine the cause so we can determine the best course of treatment for you. These other tests may include:

  • Pudendal nerve terminal motor latency test
  • Colonoscopy
  • Anal electromyography (EMG)
  • Anal manometry
  • Anal ultrasound
  • Proctography
  • Proctosigmoidoscopy
  • MRI

HOW IS RECTAL PROLAPSE TREATED?

The most commonly prescribed treatments for rectal prolapse include:

Diet - Eat more high-fiber foods such as fruits, vegetables and whole grains, adding fiber to your diet slowly to avoid problems with gas. Aim for at least six to eight glasses of water every day.

Treat constipation - This may decrease the amount of bowel that protrudes from the anus, but it is not a cure. Do not strain while having a bowel movement. Use a stool softener if needed.

Exercise - Do Kegel exercises to help strengthen the muscles of the pelvic area.

Pushing into place - Some doctors may advise that you push the prolapse back into place. Only do this if your doctor has approved it.

At Loma Linda University Health, rectal prolapse is treated with a customized care plan for the individual patient. If a patient’s rectal prolapse requires surgery, the specifics of their condition will determine which of the following procedures is performed:

Rubber band ligation - This is a common office procedure that can be used for smaller, hemorrhoidal prolapse.

Removal of prolapsed tissue - Larger prolapses may require an outpatient surgical procedure that may require removal of the prolapsed tissue.

Full-thickness rectal prolapse repair - When the patient’s condition is full-thickness rectal prolapse, repair is performed in the operating room under anesthesia. There are two approaches to repair: a perineal (transanal) approach or an abdominal approach. The perineal approach involves removing a cuff of rectal tissue through the anal canal. While the possible complications of a perineal approach are quite low, the recurrence rate for this surgery is relatively high (>30%). The perineal approach is typically reserved for patients who are unable to tolerate abdominal surgery for medical reasons.

The abdominal approach involves resuspending the rectum with either sutures or with a piece of mesh. This type of surgery is referred to as a rectopexy. A rectopexy can be performed in the traditional open fashion or in a minimally invasive way (laparoscopic or robotic surgery). A posterior rectopexy involves mobilizing the lax rectum and tacking is back into place with sutures. A ventral mesh rectopexy involves attaching a piece of mesh to the anterior surface of the rectum and then suspending the mesh with sutures.

Discuss with your surgeon the type of surgery that is most appropriate for your condition.

WHAT ARE THE COMPLICATIONS OF RECTAL PROLAPSE?

If left untreated, possible complications of rectal prolapse include:

  • Ulceration and bleeding
  • A reduction in blood supply causing strangulation of the rectum
  • Gangrene, resulting in death and decay of the strangulated section of the rectum

WHO IS AT RISK FOR DEVELOPING RECTAL PROLAPSE?

People who are most at risk of developing rectal prolapse are adults over 50 or those who have a long-term history or constipation. Others at risk include those who have had an injury to the anal or hip area or those who have nerve damage.

Combined prolapse

It is common for female patients who have rectal prolapse to also experience bladder prolapse or prolapse of the gynecologic organs (uterus, cervix, vagina), a condition known as combined prolapse. Women who are experiencing a bulging sensation in the bladder or vaginal area should report these symptoms to their gynecologist.

NEXT STEPS

  • Stay aware. If you are in the risk category for rectal prolapse, stay aware of the symptoms of this condition and seek medical intervention immediately if you begin experiencing them.  
  • Be proactive. If left untreated, rectal prolapse can lead to more serious complications. To request an evaluation at Loma Linda University Health for rectal prolapse symptoms, contact your provider or schedule the appointment through MyChart.