What Is Rectal Prolapse?

  • Aleena Rajan Master Of Public Health (MPH) -University of Wolverhampton
  • Jialu Li Master of Science in Language Sciences (Neuroscience) UCL

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We are unveiling the reality of rectal prolapse – Your Comprehensive Guide to Understanding, Preventing, and Overcoming. Don't shy away, let's talk about it!

Introduction

In the intricate tapestry of the human body, some medical disorders are frequently hidden, spoken about, or even completely disregarded because they cause discomfort. Rectal prolapse is one such illness that has to be addressed. Rectal prolapse is a condition that involves the protrusion of the rectum through the anus. It is one that has to be recognised medically and treated with proactive steps for prevention and therapy. When the lower portion of the large intestine, known as the rectum, drops and protrudes out of the anal orifice, it is known as rectal prolapse. Rectal prolapse is different from haemorrhoids in that the rectal tissue itself prolapses in this case. Rectal prolapse, which frequently manifests as symptoms like a bulging sensation or the sight of reddish tissue outside the body, can cause people to experience both physical and psychological discomfort. Although it is more frequently seen in the elderly, persons of all ages, including children, can be affected by the disorder.1

Rectal prolapse treatment is essential for several reasons. Primarily, the discomfort and other problems linked to the illness can greatly affect a person's quality of life. Rectal prolapse necessitates an all-encompassing approach to care, from constipation issues to the psychological effects of living with a disorder that affects such a private part of one's anatomy. Furthermore, successful management of rectal prolapse depends on early intervention. The danger of problems increases with the length of time the illness goes untreated and can include anything from faecal incontinence to exposed tissue ulcers. Individuals may empower themselves to identify any symptoms early on and seek medical attention in a timely manner by cultivating knowledge and understanding. The purpose of this article is to provide a thorough understanding of rectal prolapse by delving into its description, causes, symptoms, and potential therapies. By eliminating the stigma associated with rectal prolapse, we want to encourage open conversations and eventually improve the lives of individuals who are impacted by this often overlooked aspect of health.2

Types of Rectal Prolapse

The main types of rectal prolapse are:

  • Complete or Full Thickness Rectal Prolapse: In this kind, the rectum's complete wall protrudes into the anus. Since it is the most severe, medical attention is frequently needed.
  • Mucosal or Partial Rectal Prolapse: This condition solely affects the rectum's inner lining, or mucosa, which protrudes into the anus. Though less severe than a full-thickness prolapse, it can still cause discomfort and complications and has to be addressed.3
  • Internal or Occult Rectal Prolapse: This type, sometimes referred to as internal intussusception, is not noticeable from the outside. It happens when the rectum retracts inside the body instead of emerging outside. Treatment options are based on the severity of symptoms and may include specialised testing for diagnosis.4

Symptoms of Rectal Prolapse

Typical symptoms consist of:

  • Visible protrusion: The most obvious sign of total rectal prolapse is the protrusion of the rectal tissue through the anus, which can be seen when standing, walking, or even when having bowel movements.
  • Pain or discomfort: People with rectal prolapse may feel pain, aching, or a sense of fullness in the anal or rectal region. Pain may be felt when sitting down or even when passing petrol.
  • Changes in bowel motions: Bowel movement abnormalities might arise, including constipation and faecal incontinence, which is the inability to regulate one's bowel motions. This frequently results from the rectum's displacement, impairing regular bowel motion5.
  • Bleeding: If the prolapsed tissue becomes inflamed or ulcerated, bleeding may happen in the rectal area. Bright crimson blood on the toilet paper or in the toilet bowl may result from this.
  • Mucus discharge: One typical sign of rectal prolapse is the observation of a mucus discharge from the rectum by certain individuals.
  • Feeling of incomplete bowel emptying: Following a bowel movement, people may experience a feeling of partial bowel emptying because the prolapsed rectum is preventing the usual transit of faeces.
  • Pelvic pain or pressure: It is possible to have pelvic pain or pressure, which can frequently get worse by standing or walking.6

Risk factors of Renal Prolapse

Rectal prolapse is more frequent in the elderly, especially in women. Age is one risk factor for the disorder. The risk factors include a history of pelvic floor dysfunction, chronic constipation, and straining during bowel movements. Additionally, some illnesses including chronic obstructive pulmonary disease (COPD) and cystic fibrosis may make a person more susceptible. One of the main risk factors is weak pelvic floor muscles, which are frequently linked to obesity, previous pelvic surgery, and delivery. Multiple sclerosis and other neurological conditions that impair nerve function increase the risk much more. It is essential to identify these elements in order to treat and intervene in rectal prolapse as soon as possible.7

Diagnosis of Rectal Prolapse

A combination of imaging techniques, physical examination, and medical history is used to identify rectal prolapse. Rectal protrusion during bowel movements is a common symptom that patients experience. Examining the protrusion and determining its extent is part of the physical examination. To assess the severity and rule out other disorders, further procedures like a colonoscopy or defecating proctogram can be carried out. The diagnosis is confirmed by a digital rectal examination. Surgical procedures and lifestyle adjustments to pelvic floor exercises are available as treatment options, contingent on the severity of the condition. For rectal prolapse to effectively resolve, prompt diagnosis and adequate therapy are essential.8

Treatment of Rectal Prolapse

The treatment of rectal prolapse depends on the severity of the condition. Here are some common approaches:

Conservative Management

  • Dietary changes: Increasing fibre intake can help avoid constipation and reduce straining during bowel movements.
  • Pelvic floor exercises: Strengthening the pelvic floor muscles may provide support to the rectum.

Medications

  • Laxatives: To prevent constipation and reduce the strain during bowel movements.

Biofeedback therapy

This involves working with a therapist to improve awareness and control of pelvic floor muscles.9

Pessary use

A pessary is a device inserted into the vagina to support the rectum and prevent prolapse.

Surgery 

Surgical intervention is often required for more severe cases or when conservative measures fail.

Procedures include:

  • Rectopexy: Surgical fixation of the rectum to the surrounding structures.
  • Resection: Removing a portion of the rectum in some cases.
  • Altemeier Procedure: Also known as perineal proctosigmoidectomy, involves removing the prolapsed portion of the rectum through an incision in the perineum.10

Recovery and rehabilitation of Rectal Prolapse

Depending on the selected course of therapy, rectal prolapse recovery requires a customised strategy. Patients usually return to regular activities gradually over many weeks after surgery. Pain control, a soft diet, and a gradual return to normal exercise are all part of postoperative care. Exercises for the pelvic floor help to strengthen muscles. Dietary changes are recommended to patients in order to avoid constipation. Frequent check-ins with medical professionals guarantee appropriate recovery and resolve any issues. Although recovery times vary, most people may anticipate reduced symptoms and a return to their regular lives with appropriate therapy and following doctor's orders.11

Complications of Rectal Prolapse

If left untreated, more severe complications can arise. These may include:

  • Strangulation: This occurs when the prolapsed tissue loses its blood supply, leading to tissue death. Strangulation is a serious complication that requires immediate medical attention.
  • Ulcers and infections: The exposed tissue in prolapse is vulnerable to ulcers and infections due to its constant exposure to fecal matter.
  • Fecal incontinence: The weakening of the muscles and structures supporting the rectum can result in fecal incontinence, leading to difficulty controlling bowel movements.
  • Obstruction: In some cases, a rectal prolapse can cause a blockage in the intestines, leading to symptoms like abdominal pain, bloating, and constipation.
  • Psychological impact: Dealing with the symptoms and social implications of rectal prolapse can have psychological effects, such as stress, anxiety, or depression.12

Prevention of Rectal Prolapse

Maintaining a healthy lifestyle is key to preventing rectal prolapse. Incorporate high-fibre foods into your diet to promote regular bowel movements and avoid straining during defecation. Stay hydrated to ensure soft stools and practice pelvic floor exercises to strengthen muscles. Regular physical activity supports overall digestive health. Avoid prolonged sitting and be mindful of proper lifting techniques to minimize abdominal strain. See a medical expert for specific guidance if you suffer from chronic constipation or other digestive problems.13

Summary

Rectal prolapse occurs when the rectum protrudes through the anal opening. It often results from weakened pelvic floor muscles, chronic constipation, or straining during bowel movements. Symptoms include pain, bleeding, and a visible protrusion. Treatment options range from lifestyle changes and pelvic floor exercises to surgical intervention in severe cases. Early diagnosis and intervention are crucial for successful management. Seeking medical advice is imperative to determine the most appropriate course of action based on individual circumstances.

References

  1. Gourgiotis S, Baratsis S. Rectal prolapse. Int J Colorectal Dis [Internet]. 2007 Mar [cited 2023 Nov 1];22(3):231–43. Available from: https://link.springer.com/10.1007/s00384-006-0198-2
  2. Jacobs LK, Ju Lin Y, Orkin BA. The best operation for rectal prolapse. Surgical Clinics of North America [Internet]. 1997 Feb [cited 2023 Nov 1];77(1):49–70. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0039610905705326
  3. Felt-Bersma RJF, Cuesta MA. Rectal prolapse, rectal intussusception, rectocele, and solitary rectal ulcer syndrome. Gastroenterology Clinics of North America [Internet]. 2001 Mar [cited 2023 Nov 1];30(1):199–222. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0889855305701746
  4. Roig JV, Buch E, Alós R, Solana A, Fernández C, Villoslada C, et al. Anorectal function in patients with complete rectal prolapse. Differences between continent and incontinent individuals. Rev Esp Enferm Dig. 1998 Nov;90(11):794–805.
  5. R W, Da R, Sm G. Rectal prolapse. Current problems in surgery [Internet]. 1986 Jun [cited 2023 Nov 1];23(6). Available from: https://pubmed.ncbi.nlm.nih.gov/3522112/
  6. Siproudhis L, Bellissant E, Juguet F, Mendler MH, Allain H, Bretagne JF, et al. Rectal adaptation to distension in patients with overt rectal prolapse. British Journal of Surgery [Internet]. 2003 Jan 13 [cited 2023 Nov 1];85(11):1527–32. Available from: https://academic.oup.com/bjs/article/85/11/1527/6269758
  7. Goldstein S, Maxwell P. Rectal prolapse. Clinics in Colon and Rectal Surgery [Internet]. 2011 Mar [cited 2023 Nov 1];24(01):039–45. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0031-1272822
  8. Kairaluoma MV, Kellokumpu IH. Epidemiologic aspects of complete rectal prolapse. Scand J Surg [Internet]. 2005 Sep [cited 2023 Nov 3];94(3):207–10. Available from: http://journals.sagepub.com/doi/10.1177/145749690509400306
  9. Brazzelli M, Bachoo P, Grant A. Surgery for complete rectal prolapse in adults. In: The Cochrane Collaboration, editor. The Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 1999 [cited 2023 Nov 3]. p. CD001758. Available from: https://doi.wiley.com/10.1002/14651858.CD001758
  10. Hrabe J, Gurland B. Optimizing treatment for rectal prolapse. Clinics in Colon and Rectal Surgery [Internet]. 2016 Aug 19 [cited 2023 Nov 3];29(03):271–6. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0036-1584505
  11. Melton GB, Kwaan MR. Rectal prolapse. Surgical Clinics of North America [Internet]. 2013 Feb [cited 2023 Nov 3];93(1):187–98. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0039610912002034
  12. Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE. Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. J Gastrointest Surg [Internet]. 2014 May [cited 2023 Nov 3];18(5):1059–69. Available from: http://link.springer.com/10.1007/s11605-013-2427-7
  13. Azimuddin K, Khubchandani IT, Rosen L, Stasik JJ, Riether RD, Reed JF. Rectal prolapse: a search for the “best” operation. The American Surgeon [Internet]. 2001 Jul [cited 2023 Nov 3];67(7):622–7. Available from: http://journals.sagepub.com/doi/10.1177/000313480106700704

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Aleena Rajan

Master Of Public Health (MPH) -University of Wolverhampton

Dr Aleena is an Ayurvedic Physician with extensive experience in hospital and clinical settings. She holds Indian licenses and board certification in Ayurvedic Medicine. She has worked as a consultant doctor for 3 years and also as Medical Officer for 2 years. She has dedicated her career to providing comprehensive medical care and improving the well-being of her patients. Currently, she is pursuing her postgraduation in public health.

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