An ESCP Guide for Patients
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What is rectal prolapse?
The rectum is the last part of the large intestine, just before the anus.
Prolapse is a medical term used when an organ moves from its normal position. Rectal prolapse happens when the rectum slips down and protrudes through the anus. While this condition is not usually a medical emergency, it can cause discomfort and affect daily life.
Risk factors for rectal prolapse
Although the exact cause is unknown, several factors may contribute to rectal prolapse:
- It is more common in women over 50, often due to chronic constipation or multiple childbirths
- Men can also develop rectal prolapse, usually at a younger age (around 40). It may be associated with other underlying conditions such as psychiatric or eating disorders, autism, difficulty with bowel movements, or developmental delays.
Symptoms of rectal prolapse
If you have rectal prolapse, you may experience:
- A red mass protruding from the anus
- A bulge in the anal area
- Pressure or discomfort in the rectum
- Constipation or difficulty passing stool
- Fecal incontinence (inability to control bowel movements)
- Feeling like your bowel is not completely empty
- Mucus discharge from the rectum
- Rectal bleeding
- Anal pain or itching
How is rectal prolapse diagnosed?
Medical history and examination
Your doctor will take a detailed medical history and perform a physical examination. They may ask about constipation, incontinence, urinary symptoms, or a feeling of a bulge in the anus.
If the prolapse is not visible during the exam, your doctor may ask you to strain as if having a bowel movement while sitting on the toilet. You might also be asked to take a photo at home to help with the diagnosis.
Additional tests
If the prolapse is difficult to diagnose during the exam, your doctor may order:
- Proctogram: an X-ray or MRI taken while you pass stool to assess how the rectum functions
- Anorectal physiology tests: a small tube is placed in the anus to measure muscle strength and nerve responses
- Colonoscopy/sigmoidoscopy: a small camera is inserted into the rectum to examine the inside of the large bowel
Treatment options for rectal prolapse
Non-surgical treatment
Rectal prolapse cannot be cured without surgery, but medications can help relieve symptoms while waiting for surgery:
- Fibre supplements and stool softeners may help with constipation
- Prolapse itself does not cause cancer, early treatment can prevent symptoms from worsening and reduce the risk of complications like incarceration (when the prolapse becomes stuck outside the anus).
Surgical treatment
Surgery is the only definitive treatment for rectal prolapse. The procedure depends on factors such as age, overall health, and severity of symptoms.
Abdominal surgery (rectopexy)
This is the most common procedure and is performed through the abdomen. It involves lifting and securing the rectum to the sacrum (lower spine) to keep it in place using a mesh designed for this purpose.
Surgery is usually done minimally invasive. Minimally invasive surgery (MIS) is an approach to surgery that minimises cutting through your skin and tissues. Surgeons use MIS techniques and technology (such as laparoscopy or a robot) to cause as little trauma as possible during your procedure. Smaller cuts reduce your potential for pain, complications and recovery time.
In some severe cases, a portion of the bowel may be removed if constipation is a major issue. While surgery can improve rectal prolapse, it may not fully restore normal bowel function, and some patients may still experience constipation or incontinence after the procedure.
Perineal (transanal) surgery
Perineal surgery is usually considered for older patients or those who cannot undergo abdominal surgery due to various reasons. It is also used in emergency cases where the prolapse has become trapped outside the body (incarceration).
Types of perineal surgery:
- Altemeier’s procedure: the prolapsed portion of the rectum is removed, and the remaining bowel is reconnected. This is recommended for larger prolapses.
- Delorme’s procedure: only the inner lining of the prolapsed rectum is removed, and the remaining tissue is folded and stitched. This is typically used for smaller prolapses.
When to see a doctor
If you notice symptoms of rectal prolapse as described above, consult your doctor or colorectal surgeon for personalised advice.
Disclaimer
The information provided here is general and hopes to correctly inform the patient to the extent possible. However, this document cannot discuss all aspects of a specific condition or procedure, or of the individual patient.
The decision on which procedure will give you the best result is made by your doctor or colorectal surgeon during consultation and based on shared and informed decision-making with the patient.