Rectal prolapse occurs
when part or all of the
wall of the rectum slides out of place, sometimes
sticking out of the anus. See a picture of
rectal prolapse.
Partial prolapse (also called mucosal
prolapse). The lining (mucous membrane) of the rectum slides out of place and
usually sticks out of the anus. This can happen when you strain to have a bowel movement. The
condition may be confused with
internal hemorrhoids. (See a picture of a
hemorrhoid.) Partial prolapse is most common in
children younger than 2 years.
Complete prolapse. The entire
wall of the rectum slides out of place and usually sticks out of the anus. At
first, this may occur only during bowel movements. Eventually, it may occur
when you stand or walk. And in some cases the prolapsed tissue may remain
outside your body all the time.
Internal prolapse (intussusception). One part of the wall of the large
intestine (colon) or rectum may slide into or over another part, like the
folding parts of a telescope. The rectum does not stick out of the anus. (See
a picture of
intussusception.) Intussusception is most common in
children and rarely affects adults. In children, the cause is usually not
known. In adults, it is usually related to another intestinal problem, such as
a growth of tissue in the wall of the intestines (such as a
polyp or tumor).
In severe cases of rectal prolapse, a section of the
large intestine drops from its normal position as the tissues that hold it in
place stretch. Typically there is a sharp bend where the rectum begins. With
rectal prolapse, this bend and other curves in the rectum may straighten,
making it difficult to keep stool from leaking out (fecal incontinence).
Rectal prolapse is most common in children
and older adults, especially women.
What causes rectal prolapse?
Many conditions
increase the chance of developing rectal prolapse. Risk factors for children
include:
Cystic fibrosis. A child who has rectal prolapse with no obvious cause may need
to be tested for cystic fibrosis.
Having had surgery on the anus as an infant.
Malnutrition.
Deformities or physical development
problems.
Straining during bowel
movements.
Infections.
Risk factors for adults include:
Straining during bowel movements because of
constipation.
Tissue damage caused by surgery or
childbirth.
Structural conditions present since
birth.
Weakness of pelvic floor muscles that occurs naturally with
age.
What are the symptoms?
The first symptoms of
rectal prolapse may be:
Leakage of stool from the anus (fecal
incontinence).
Leakage of mucus or blood from the anus (wet anus).
Other symptoms of rectal prolapse include:
A feeling of having full bowels and an urgent
need to have a bowel movement.
Passage of many very small
stools.
The feeling of not being able to empty the bowels
completely.
Anal pain, itching, irritation, and
bleeding.
Bright red tissue that sticks out of the anus.
How is rectal prolapse diagnosed?
Your doctor will
diagnose rectal prolapse by asking you questions about your symptoms and past
medical problems and surgeries. He or she will also do a physical exam. He or she may do
tests to rule out other conditions.
How is it treated?
Prolapse in children tends to
go away on its own.
In adults, eating plenty of foods that
contain fiber may improve partial (mucosal) prolapse caused by constipation and
straining. But surgery is usually needed if you have a complete prolapse
or a partial prolapse that does not improve with a change in diet. Surgery
involves attaching the rectum to the muscles of the pelvic floor or the lower
end of the spine (sacrum). Or surgery might involve removing a section of the
large intestine that is no longer supported by the surrounding tissue. Both
procedures may be done in the same surgery.
The first sign of
rectal prolapse is often the unexpected release of
mucus, stool, or blood from the
anus.
Other symptoms of rectal prolapse
include:
A feeling of having full bowels and an urgent
need to have a bowel movement.
Passage of many very small
stools.
The feeling of not being able to empty the bowels
completely.
An inability to control bowel movements (fecal incontinence) that becomes worse over
time.
Anal pain, itching, irritation, and
bleeding.
Bright red tissue that protrudes from the anus.
You may notice tissue slipping out of the anus during a
bowel movement. As the condition becomes worse, tissue may slide out of the
anus when you stand and then may remain outside the anus all the time.
Prolapse of only the lining of the
rectum (partial prolapse) can be confused with
hemorrhoids. In partial prolapse, rings of red tissue
usually protrude out of the anus while you strain during a bowel movement. In
hemorrhoids, the tissue that protrudes out of or next to the anus may look like
a red or blue lump, and there may be several lumps.
Complications
Rectal prolapse that is not treated
can lead to complications.
Fecal incontinence may become worse. And
permanent damage can occur to the circular muscle that controls the anus (anal sphincter).
The rectum can become damaged from the tissues
rubbing together, which can result in a sore (ulcer) that may
bleed.
Normal blood flow to tissue in the rectum may be cut off. This causes the tissue to die (gangrene).
If a prolapsed rectum swells,
it may prevent the passage of stools.
In rare cases, a loop of the large
intestine is pinched off (strangulated), causing blockage of the intestine
(bowel obstruction).
A doctor can diagnose
rectal prolapse by asking you questions about your
symptoms and by doing a physical exam. The doctor may ask questions
about when your symptoms began and whether they have changed over time.
Your doctor may ask whether you have had:
Leakage of mucus or stools that may
stain underwear.
Any tissue that slips out of your anus and when
it occurs.
Also, your doctor may ask about any past surgeries or
medical conditions, such as whether you have:
Had rectal surgery.
Had pelvic
surgery, such as the removal of your uterus (hysterectomy).
Had a
back injury, surgery, or condition such as
spina bifida.
Given birth, how many times
you have given birth, and whether you ever had complications, such as not being
able to control your bladder or bowels after delivery (stress incontinence).
Used
laxatives or enemas regularly or used other products to help with bowel
movements.
The physical exam usually includes:
Examining the rectum with a gloved finger to
feel for loose tissue and to find out how strongly the
anal sphincter contracts. You may be asked during the
exam to strain as you would during a bowel movement. The doctor may observe the
anus while you strain to test the strength of your pelvic muscles and to see
whether tissue drops out of your anus.
Inspecting the skin around
the anus for irritation, which may indicate a discharge of mucus, contact with
stools, or excessive cleaning.
Testing the sensation around the
anus with sharp and dull instruments to determine how well the nerves are
working.
Other tests are often done to rule out other conditions
that may be contributing to the problem. These tests may include:
See a doctor
if you or your child has symptoms of
rectal prolapse. Sometimes home treatment such as
eating a high-fiber diet can reverse the prolapse.
If the problem
does not go away, you may need further treatment. This may include surgery,
especially when the whole rectal wall and not just the lining sticks out of the
anus (complete prolapse).
Treatment of children with rectal prolapse
In
children, rectal prolapse usually goes away on its own. A parent or other
caregiver often can manage the rectal prolapse with home care methods until it
heals. If your child has a
rectal prolapse, you can help prevent the prolapse
from coming back by:
Pushing the prolapse back into place as soon
as it occurs. Wear disposable latex gloves and use lubricating jelly. Applying
an ice pack can help decrease swelling.
Having the child use a
small toilet that is placed on the floor. This will help support the child's
buttocks so that he or she will not have to strain while having a bowel
movement.
Most children who develop rectal prolapse between the
ages of 9 months and 3 years will respond to home treatment. In these cases,
prolapse usually does not continue after age 6.
If a medical
condition, such as
cystic fibrosis, is causing rectal prolapse, it will
usually need to be treated to resolve the prolapse.
If rectal
prolapse is not caused by another condition or does not respond to home
treatment, your child may need other treatment. Injecting a chemical called a
sclerosant into the wall of the rectum can be very effective at treating rectal
prolapse in children who do not improve after home treatment.
Treatment of adults with rectal prolapse
Treatments for rectal prolapse in adults focus on changes in diet,
medicine (such as stool softeners), and surgery. Treatment choice depends on
the type of prolapse, whether you have other physical problems, your age, your
activity level, and whether you can do home treatment. Home treatments usually
are tried first, because surgery does not always cure the condition.
You may treat a prolapse of the lining (partial prolapse) by changing
your diet to reduce constipation and straining during a bowel movement. Adding
fiber to your diet increases the amount of water in
your stools and helps them move through the large intestine quickly. You may
also use a prescription medicine, such as lactulose, that softens stools and
allows them to move through the intestines and pass easily.
If
you have a partial prolapse that does not improve with a change in diet or
other self-care, you may need surgery to secure or remove tissue that slides
out of the anus.
If you need surgery, the type of procedure
depends on the size of the prolapse and your overall health. This includes any
symptoms you have as well as other physical problems that may contribute to the
prolapse.
Two
types of surgery are used to treat a complete prolapse. A surgeon may operate
through the belly to secure part of the large intestine or rectum to the inside
of the abdominal cavity (rectopexy). Sometimes the surgeon removes the affected
part of intestine. This type of surgery is most often used for younger,
physically fit people.
Surgery also can be done through the area
between the genitals and the anus (perineum) to
strengthen the
anal sphincter. This type of surgery is best for
people who are elderly or are not physically fit.
Surgery is most
often successful for people who still have some control over the anal
sphincter. If the sphincter is damaged, surgery may correct the prolapse but
not be able to completely correct
fecal incontinence. In some cases, fecal incontinence
can become worse.
If your child has a
rectal prolapse, you can help prevent the prolapse
from coming back.
Push the prolapse back into place as soon as
it occurs. Wear disposable latex gloves and use lubricating jelly. Apply an ice
pack to help decrease swelling.
Have the child use a small toilet
that is placed on the floor. This will help support the child's buttocks so
that he or she will not have to strain while having a bowel movement.
Home treatment for adults
Protruding tissue caused
by rectal prolapse often can be pushed back into place. Stand with your chest
tucked as closely to your thighs as you can. Using a wet, gloved finger or a
soft, warm, wet cloth, gently reinsert any tissue that comes out of the anus.
If the rectal tissue cannot be inserted easily into the anus, see your
doctor.
Other measures you can take at home that can help rectal
prolapse include the following:
Drink plenty of water. And eat fruits,
vegetables, and other foods that contain fiber. A
high-fiber diet can help prevent constipation and
reduce the need to strain during a bowel movement. Changes in diet often are
enough to improve or reverse a prolapse of the lining of the rectum (partial
prolapse), which does not always protrude from the
anus.
Do
Kegel exercises to help strengthen the muscles of the
pelvic area. Although these exercises usually are used to help prevent urinary
incontinence and prolapse of the uterus, they also can strengthen muscles in
the pelvic area and may improve symptoms of rectal prolapse in both men and
women.
Do not strain while having a bowel movement.
Use
stool softeners to prevent straining. Stool softeners include lubricants, such
as docusate (for example, Colace), and fiber supplements, such as psyllium (for
example, Metamucil).
Sometimes you may need to use a laxative or an
enema if diet alone will not relieve constipation.
The American Society of Colon and Rectal Surgeons is the leading
professional society representing more than 1,000 board-certified colon and
rectal surgeons and other surgeons dedicated to treating people with diseases
and disorders affecting the colon, rectum, and anus.
Patel SM, Lembo AJ (2006). Rectal prolapse and
solitary rectal ulcer syndrome section of Constipation. In M Feldman et al.,
eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 1, pp. 230–231. Philadelphia: Saunders Elsevier.
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