Rectal Prolapse

What Is Rectal Prolapse?

Prolapse is when any body part slips or falls down from its normal position. Rectal prolapse is when your rectum -- the last section of your large intestine -- drops down or slides out of your anus. While that may sound scary, it’s typically not considered a medical emergency. However, the longer you have the condition, the worse it can get. Living with rectal prolapse can cause embarrassment and affect your quality of life.

If you feel like something just isn’t right when you go to the bathroom, or try to poop, you shouldn’t ignore it or make light of it. Your doctor can diagnose rectal prolapse and suggest treatment to fix it.

Types of Rectal Prolapse

There are three types of prolapse:

  • External prolapse: The entire rectum sticks out of your anus.
  • Mucosal prolapse: Part of the rectal lining pokes out of your anus.
  • Internal prolapse: The rectum has started to drop but is not yet sticking out of your anus.

Rectal Prolapse Symptoms

If you feel like you’re sitting on a ball after pooping, or if you notice that you have something sticking out of the opening (your anus) where you poop, you could have rectal prolapse.

Typically, you’ll first experience rectal prolapse after you have a bowel movement. The first time, or first few times, the rectum may return inside on its own. Later, you may feel like something has fallen out of your body, or you just feel something down there that isn’t normal. In those cases, you may be able to push the rectum back in yourself.

Additional symptoms of rectal prolapse can include:

  • Feeling a bulge outside your anus
  • Seeing a red mass outside your anal opening
  • Pain in the anus or rectum
  • Bleeding from the rectum
  • Leaking blood, poop, or mucus from the anus

Early on, rectal prolapse may look like hemorrhoids slipping out of your anal opening, but these are two different conditions. Hemorrhoids are swollen blood vessels in your anus or lower rectum that may cause itching, pain, and blood on the toilet paper when you wipe after you poop. Your doctor can diagnose whether you have rectal prolapse or hemorrhoids.

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Rectal Prolapse Causes

A variety of things can cause the condition, including:

  • Long-term history of diarrhea or constipation
  • Long-term history of having to strain when you poop
  • Old age, which weakens muscles and ligaments in the rectal area
  • Previous injury to the anal or hip area
  • Nerve damage that affects your muscles’ ability to tighten and loosen, which could be caused by pregnancy, vaginal childbirth complications, anal sphincter paralysis, or injury to your spine or back
  • Neurological problems, such as spinal cord disease or spinal cord transection

Rectal Prolapse Risk Factors

More women develop rectal prolapse than men, especially women older than 50. In general, older people who have had a history of constipation or problems with their pelvic floor have a higher chance of having the problem.

Any of these health conditions could put you at higher risk for rectal prolapse:

  • Chronic constipation
  • Always have to strain to poop
  • Lower back injury or disc disease
  • Muscle weakness in your anus or pelvic floor
  • Someone in your family also had rectal prolapse
  • Parasitic infections like schistosomiasis
  • Chronic obstructive pulmonary disorder (COPD)
  • Benign prostatic hypertrophy
  • Any injury or problems with ligaments that keep your rectum attached to the intestinal wall
  • Congenital bowel disorders like Hirschsprung’s disease or neuronal intestinal dysplasia

Rectal Prolapse Diagnosis

Your doctor can do a rectal exam. While you may hesitate to do this, your doctor may ask you to sit on a toilet and poop or at least try to go. This is helpful because it allows your doctor to see the prolapse.

You may need some other, more advanced tests to diagnose rectal prolapse, especially if you have other related conditions:

  • Anal electromyography (EMG): This test checks to see if nerve damage is causing your anal sphincter problems.
  • Anal manometry: A thin tube is inserted into your rectum to test muscle strength.
  • Anal ultrasound: A probe inserted into your anus and rectum is used to examine muscles and tissues.
  • Pudendal nerve terminal motor latency test: It checks your pudendal nerves, which you use to control bowel movements.
  • Proctography: X-ray videos of your rectum during a poop show how well it holds and releases feces.
  • Colonoscopy: A long tube inserted into your rectum with a tiny camera at the end can show the inside of your intestines and look for any problems that may be causing your prolapse.
  • Proctosigmoidoscopy: This test also uses a long tube with a camera on the end. It’s inserted deep into your intestines to look for inflammation, scarring, or a tumor.
  • MRI: Imaging scan examines all of the organs in your pelvic area.

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Rectal Prolapse Treatment

The most common treatment for rectal prolapse is surgery to put the rectum back in place, and there are several types. The kind of surgery your doctor recommends will depend on factors such as your overall health, age, and how serious your condition is. The two most common types of surgery:

  • Abdominal: This type of surgery can be done either with a large incision or using laparoscopy, which uses small cuts and a camera attached to an instrument so the surgeon can see what needs to be done and if there are any additional issues that need to be fixed.
  • Perineal: Also called rectal repair, this approach may be used if you are older or have other medical problems. This type of surgery can involve the inner lining of the rectum or the portion of the rectum extending out of the anus.

If your rectal prolapse is very minor and it is caught early, your doctor might have you treat it by taking stool softeners to make it easier to go to the bathroom and by pushing the rectum’s tissue back up the anus by hand. But, typically, you will eventually need to have surgery to fix rectal prolapse.

Rectal Prolapse Prevention

To prevent rectal prolapse, try not to strain when you poop. Try these tips to ease or prevent constipation that leads to straining:

  • Get more fiber in your diet. Aim for at least five servings of fruits and veggies each day.
  • Drink 6 to 8 glasses of water a day.
  • Get regular exercise.
  • Keep your weight at a healthy level or lose weight if you need to.
  • If you have constipation often, talk to your doctor. They may direct you to take a stool softener or laxative.

Avoid heavy lifting, as this could put pressure on your bowel muscles.

Rectal Prolapse Complications

Rectal prolapse, if it’s not treated, could lead to these complications:

  • Rectal damage like ulceration or bleeding
  • Your rectum can’t be manually pushed back up inside you
  • Strangulation, or the blood supply in your rectum is reduced
  • Gangrene, or the strangulated rectal tissue decays and dies
WebMD Medical Reference Reviewed by Neha Pathak, MD on August 26, 2020

Sources

SOURCES:

Foundation of the American Society of Colon and Rectal Surgeons: Rectal Prolapse Expanded Version.

Cleveland Clinic: “Rectal Prolapse.”

Mayo Clinic: “Rectal Prolapse Surgery.”

American Congress of Obstetricians and Gynecologists: “Laparoscopy.”

American Society of Colon and Rectal Surgeons: “Rectal Prolapse.”

Victoria State Government Better Health: “Rectal Prolapse.”

University of Massachusetts Memorial Medical Center: “What Is Rectal Prolapse?”

Cedars-Sinai Hospital: “Rectal Prolapse: What is rectal prolapse?”
 

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