Rectal prolapse is a condition when all or part of the rectum wall slides out of place, sometimes protruding from the anus. The rectal lining is a dark red, moist, fingerlike projection. It can create an inability to control bowel movements, causing stool to leak from the rectum. Prolapse can be external, mucosal, or internal:
- External prolapse – The entire rectum wall slides out of place and protrudes from the anus.
- Mucosal prolapse – Part of the rectal lining protrudes from the anus.
- Internal prolapse – The rectum has started to drop but is not yet protruding.
Rectal prolapse typically occurs in older women, but it can occur in either gender or any age, including children.
Risk factors include multiple births and vaginal delivery, which is why women are more susceptible. Other risk factors are:
- Long-term history of diarrhea or constipation
- Straining during bowel movements
- Tissue damage caused by surgery (or childbirth)
- Weakening pelvic floor muscles due to age
Typically, rectal prolapse is initially experienced after a bowel movement. It may feel like sitting on a ball, or something may be sticking out of the anus. Other symptoms include stool, mucous, or blood leakage from the anus. Over time, symptoms are:
- Feeling an urgent need to have a bowel movement or full bowels
- Passage of many small stools
- Bowels not feeling completely emptied
- Anal pain, itching, irritation, or bleeding
Rectal prolapse symptoms should not be confused with hemorrhoids. Hemorrhoids are swollen blood vessels in the anus or lower rectum that may cause itching, pain, and blood on toilet paper after a bowel movement.
We conduct a rectal exam and discuss symptoms, past medical problems, and surgeries. If other related conditions are present, advanced tests may be needed as follows:
- Anal electromyography (EMG) to check for nerve damage.
- Anal manometry to test muscle strength.
- Anal ultrasound to examine muscles and tissues.
- Proctography to determine how well the rectum holds and releases feces.
- Colonoscopy or proctosigmoidoscopy to look inside the intestines.
- Defocography using a contrast agent with an x-ray or MRI to reveal structural changes in the lower gastrointestinal tract.
Rectal prolapse can occur in children, too, but it typically heals without surgery. Rectal prolapse in adults is treated surgically to put the rectum back in place. This involves attaching the rectum to the muscles of the pelvic flow or the lower end of the spine. It could also involve removing a section of the large intestine that is no longer supported by surrounding tissues. Both procedures may be necessary.