Understanding Rectal Prolapse: Causes, Symptoms, and Treatment Options

If you or a loved one is experiencing bowel incontinence or discomfort in the anal area, it may be a sign of rectal prolapse. This condition occurs when the lining of the rectum, the last section of the large intestine, drops down or slides out of the anus. While rectal prolapse is not usually considered a medical emergency, it can worsen over time and significantly impact your quality of life.

What Causes Rectal Prolapse?

Several factors can contribute to the development of rectal prolapse, including:

• Long-term history of diarrhea or constipation

• Chronic coughing or sneezing

• Aging, which can lead to weakening of muscles and ligaments in the rectal area, most commonly in females over 50 who have had multiple vaginal deliveries

• Previous injury to the anal or hip area

• Nerve damage affecting muscle control

• Neurological problems, such as spinal cord disease or transection, diabetic neuropathy, long-term straining or multiple sclerosis

Rectal prolapse is more common in older adults, especially those assigned female at birth, and individuals with a history of constipation or pelvic floor problems.

Recognizing the Symptoms of Rectal Prolapse

The most common signs and symptoms of rectal prolapse include:

• Feeling a bulge outside your anus

• Seeing a red mass protruding from your anal opening

• Pain, discomfort, or itching in the anus or rectum

• Difficulty controlling bowel movements (fecal incontinence)

• Bleeding, mucus, or stool leakage from the anus

If you experience any of these symptoms, it's essential to consult with your healthcare provider for an accurate diagnosis and appropriate treatment plan.

Diagnosing Rectal Prolapse

To diagnose rectal prolapse, your doctor may recommend one or more of the following tests:

• Digital rectal exam

• Anal electromyography (EMG)

• Anal manometry

• Anal ultrasound

• Proctography or defecography

• Colonoscopy

• MRI or lower GI series

These tests can help your doctor determine the severity of your condition and rule out other possible causes of your symptoms, such as hemorrhoids.

Treatment Options for Rectal Prolapse

Treatment for rectal prolapse depends on the severity of the condition and the individual's overall health. In mild cases, self-care measures like taking stool softeners, Kegel exercises, and manually pushing the prolapsed tissue back into the anus may be sufficient. However, most adults with rectal prolapse will eventually require surgery to correct the problem.

The two most common surgical procedures for rectal prolapse are:

1. Rectopexy: This surgery involves tacking the rectum back in place through incisions in the abdomen, either with a large cut or using laparoscopy.

2. Perineal surgery: Also called rectal repair, this procedure is typically used for older patients, those with minor prolapse, or when the rectum is stuck to the skin outside the body. There are two main types of perineal surgery: the Altemeier procedure and the Delorme procedure.

After surgery, patients typically spend a short time in the hospital and gradually return to normal activities within 4-6 weeks. To prevent recurrence and promote healing, your doctor may recommend lifestyle changes such as increasing fiber intake, staying hydrated, and avoiding straining during bowel movements.

Preventing Rectal Prolapse

While not all cases of rectal prolapse can be prevented, there are steps you can take to reduce your risk:

• Eat a high-fiber diet with plenty of fruits and vegetables

• Drink 6-8 glasses of water daily

• Exercise regularly

• Maintain a healthy body weight

• Avoid straining during bowel movements

• Seek treatment for chronic constipation or diarrhea

If you suspect you have rectal prolapse or are experiencing any unusual symptoms related to your bowel movements, don't hesitate to consult with your healthcare provider. Early diagnosis and treatment can help prevent complications and improve your overall quality of life. For more information on digestive health, visit the National Institute of Diabetes and Digestive and Kidney Diseases website.