Rectal Prolapse

Prolapse occurs when an organ protrudes or falls from its normal position.  Rectal prolapse describes the situation when the rectum (the portion of the large intestine situated just above the anal canal) protrudes towards (incomplete prolapse) or through (complete prolapse) the anus.

What causes rectal prolapse?
When the rectum falls away from the connective tissue which holds it place, patients experience an uncomfortable sensation of fullness and the need to strain in order to pass stool. This, in turn, exacerbates the problem and leads to worsening prolapse, with resultant stretching/ weakening of the anus and, ultimately, leakage of stool or mucus.  As the delicate lining of the rectum is exposed to the external environment it becomes inflamed, leading to pain and bleeding.  The condition occurs in both males and females, but it is much more common in women.

What are the risk factors for rectal prolapase?
Several factors are likely involved in the development of rectal prolapse.  Most common are a long history of straining to have bowel movements or the inability of the aging pelvic attachments and musculature to overcome nerve and muscle injury suffered during childbirth in the past.   Other, less common, causes include spinal cord disease or injury.  It can also be a component of generalized pelvic floor dysfunction, associated with prolapse of other pelvic organs as well.

How is rectal prolapse diagnosed?
If you are experiencing any of the above symptoms, a careful history and a complete anorectal examination is performed to confirm the presence of rectal prolapse, as opposed to prolapsed hemorrhoids, which often exhibit similar symptoms.  The examiner may ask the patient to strain on the toilet in an attempt to reproduce the prolapse. Because rectal prolapse can be associated with slow-transit constipation, prolapse of other pelvic organs, as well as enteroceles, additional tests are often required to determine and tailor the most effective surgical intervention for each patient.  This may include specialized X-ray or MRI studies, studies to determine the transit time of the colon, and testing the nerve and muscle function essential to bowel movements.

How is rectal prolapse treated?
There are many different ways to surgically correct rectal prolapse.  Based on your specific situation, abdominal or rectal surgery may be suggested.  The decision to recommend an abdominal or rectal surgery takes into account many factors, including age, physical condition, extent of prolapse and the results of various tests 

What is the prognosis after surgery?
A great majority of patients are completely relieved of symptoms, or are significantly helped, by the appropriate procedure. Success depends on many factors, including the status of a patient’s anal sphincter muscle before surgery, which operation was performed, and the overall condition of the patient. It may take up to a year to determine the ultimate impact of the surgery on bowel function.

If the anal sphincter muscle sustained chronic, diffuse damage as a result of the rectal prolapse, it can take up to a year for recovery of sphincter muscle function.  In some cases, full bowel control is never regained, despite repair of the prolapse.  Additionally, it is vital to avoid constipation and straining that initially caused the prolapse after surgical correction, as the risk of recurrence can be high, depending on which operation was performed.