Rectal Prolapse - Treatment, Diagnosis, Causes & Symptoms

What Is Rectal Prolapse?

Rectal prolapse is an event in which the rectum, or large intestine, slips out of place and protrudes through the anus. Prolonged straining during defecation (such as sitting on number two for days at a time) can make this condition more likely to develop.

Prognosis

If the prolapsed tissue is pushed back into place before it becomes strangulated, recovery will be likely to occur with good medical care. However, if strangulation occurs, surgery may be necessary to suture the tissue back into place.

The prognosis for recovery of bowel function after surgery ranges from 5% to 80%. If there has been significant damage caused by severe straining over many years... a patient's quality of life may be significantly reduced if restoration of normal bowel function does not occur.

A new theory suggests that some patients with rectal prolapse have a weakened pelvic floor due to the overuse of intra-abdominal pressure as a way to control incontinence. In this study, researchers found that some patients also encountered difficulty in emptying the rectum, an issue often associated with those who develop fecal incontinence.

Rectal prolapse which is treated by surgery is called "treated rectal prolapse". The surgery is called "surgical rectal prolapse repair".

When the rectum enters the pelvis, it swells and can be felt as a mass in the lower abdomen. The prolapse occurs when the muscle tissue surrounding the anus becomes weak and can no longer support the rectum, with it slipping through as a result.

Currently, there is no established risk factor for this condition; however, prolonged use of hard toilet seats has been linked to this phenomenon.

The muscles of those with idiopathic fecal incontinence may be vulnerable to mild collagen damage which causes weakness and perforation of these muscles. The actual mechanism of prolapse is unclear.

A physician can diagnose rectal prolapse during a physical examination by observing the weakened muscles and the presence of an abdominal mass. Additional tests such as proctography, anorectal manometry can be done to diagnose this condition and if possible its cause.

A proctoscope, a long thin flexible lighted tube, can also be used to view the condition and determine if surgery is needed.

Prognosis is dependent on the severity of the prolapse; those with milder cases tend to recover quickly with medical treatment whereas those who have undergone long periods of constipation will likely need surgery for a permanent repair.

Frequently Asked Questions On Rectal Prolapse

What Is Surgical Intervention For Symptomatic Rectal Prolapse?

Surgical intervention for symptomatic rectal prolapse often requires the use of permanent sutures. Sutures are used to provide additional support to the weakened muscles by creating a hammock to prevent further prolapse.

Rectal prolapse is most commonly repaired using the procedure described by Lichtenstein et al. The procedure is performed under general anesthesia and involves fixation of the prolapsed structure with permanent sutures that are placed through the mesentery of the rectum around the anus.

How Common Is It?

Prolapse of the rectum is a relatively common condition, occurring in about 10% of the population. The number of patients with symptomatic prolapse appears to be increasing with time (Phillpot et al., 2010).

The cause of this increase in incidence is unclear; however, one theory suggests that it is due to an increase in straining during defecation, with chronic constipation leading to prolapse (Phillpot et al., 2010).

The mechanism(s) whereby prolapse causes symptoms is largely unknown. It has been postulated that mild or severe constipation causes perirectal nerve compression and the resultant weakness which then causes compression of the rectal wall (Robertt, 2008).

When Can I Expect To Resume My Regular Activities And How Long Before I See Results?

Immediately after surgery, you may begin walking and sitting in a chair. It will take 4-6 weeks for your bowel movements to return to normal. It will take 2-3 months before you notice a significant difference in stool consistency and your ability to control your bowels without leakage or urge incontinence.