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Rectal Prolapse

by Parswa Ansari, MD

Rectal prolapse is a painless protrusion of the rectum through the anus.

  • A rectal prolapse is often caused while straining, such as during a bowel movement.

  • The diagnosis is based on an examination and various viewing and imaging tests.

  • Rectal prolapse in infants and children usually heals without surgery.

  • Rectal prolapse in adults is treated surgically.

Rectal prolapse causes the rectum to turn inside out, so that the rectal lining is visible outside the body as a dark red, moist, fingerlike projection from the anus. Bleeding from the rectum can occur, and an uncontrolled loss of stool (fecal incontinence) is a frequent symptom. Less commonly, the rectum protrudes into the vagina (rectocele—see Rectocele). This disorder causes pain only when complications occur or when the prolapse is severe.

A temporary prolapse of only the rectal lining (mucosa) often occurs in otherwise healthy infants, probably when the infant strains during a bowel movement, and is rarely serious. In adults, prolapse of the rectal lining tends to persist and may worsen, so that more of the rectum protrudes.

A complete prolapse of the rectum (sometimes formally called procidentia, but this term can refer to any complete organ prolapse) occurs most often in women older than age 60.

Diagnosis

  • A doctor's examination

  • Sigmoidoscopy, colonoscopy, or barium enema x-rays

To determine the extent of a prolapse, a doctor examines the area while the person is standing or squatting and straining. By feeling the anal sphincter with a gloved finger, a doctor often detects diminished muscle tone. A sigmoidoscopy, colonoscopy, or barium enema x-rays of the large intestine may reveal an underlying disease.

Treatment

  • Elimination of causes of straining

  • For infants and children, strapping the buttocks together

  • For adults, sometimes surgery

In infants and children, a stool softener eliminates the urge to strain. Strapping the buttocks together between bowel movements usually helps the prolapse heal on its own.

In adults, surgery is usually needed to correct the problem. Surgery often cures procidentia. During one kind of abdominal operation (called rectopexy), the entire rectum is lifted, pulled back, and attached to the sacral bone in the pelvis. In another operation, a segment of the rectum is removed, and the remainder of the rectum is stitched to the sacral bone.

For people who are too weak to undergo surgery because of extreme old age or poor health, surgery on the rectum is preferred to surgery on the abdomen. One type of surgery on the rectum is done by inserting a wire or plastic loop to encircle the sphincter in a technique called the Thiersch procedure. Alternatively, a segment of the rectum or the excess lining of the rectum may be cut out (excised).