Rectal Prolapse

Background

The rectum is the final segment of the large intestine. It is a sort of passage that connects the large intestine with the anus which is the external orifice through which feces is evacuated from the body. The rectum is a muscular tube that stores feces before it is eliminated through the anus. The innermost layer of the rectum which is in direct contact with feces is known as its mucosa. The rectal mucosa secretes mucus, a fluid substance, which helps lubricate the passage of feces.

What Is Rectal Prolapse?

The word ‘prolapse’ is used to describe the condition where an organ slips out of its normal position. In the case of the rectum, it can actually turn itself inside out and slip part of the way out of the anus. This can happen to children as well as adults. Among adults, it is more likely to occur as a result of chronic constipation.

In the early stages, it is fairly easy to correct a rectal prolapse. But if this condition goes unattended and if its underlying causes are not rectified or treated, it can worsen and the patient may develop fecal incontinence and require surgery to cure the problem.

Why Do Some People Suffer From Rectal Prolapse?

Rectal prolapse is more common among young children and older adults. Women who have gone through childbirth are also at risk because this can weaken the muscles of the pelvic floor and leave them unable to properly support the pelvic organs and the rectum. Prolapse is also likely to occur when a person has been in the habit of straining while passing motions. Over time, this behavior tends to weaken the muscles of the rectum and the structures supporting it. The age-related weakening of the anal sphincter is also a contributing factor.

Here are some well-known risk factors for rectal prolapse:

• Chronic constipation.
• Chronic diarrhea.
• Straining during bowel movements.
• Lack of fiber in the diet.
• Cystic fibrosis.
• Diabetes.
• Intestinal Infections.
• Weakening of the pelvic floor as a result of pregnancy and childbirth.
• Difficult childbirth or prolonged labor.
• Delivering a large baby.
• Damage to the nerves as a result of spine injury or surgery.
• Age-related weakening of the pelvic floor muscles.
• Weakening of anal sphincter.
• Prior surgery on the anus.
• Malnutrition.

What Are The Different Degrees Of Prolapse?

A patient may have an internal prolapse, a partial rectal prolapse or a complete rectal prolapse. In the initial stages, a portion of the rectal wall may droop downwards towards the anus but it may not actually reach all the way till the opening of the anus. This is known as internal prolapse.

In the next stage, part of the rectal mucosa protrudes slightly out of the anus. This tends to occur after passing motions or when the patient strains during bowel movements. The patient may be able to feel this but it will not usually be externally visible or only slightly if at all. At this stage, the protruding section can be pushed back inside carefully. This is known as partial or mucosal prolapse.

In more severe cases, the rectum completely and visibly protrudes out of the anus as a fleshy mass. In such cases, the patient will most probably require surgery to cure the problem and prevent complications.

How Can One Recognise This Condition? What Are The Symptoms?

In case of an internal prolapse, the patient may not notice that there is a problem. However, if the rectum is partly protruding from the anus, the patient will be able to observe this. This tends to occur soon after passing motions. In case of a complete prolapse, the section of the rectum protruding through the anus will be unmistakable.

Here is a list of symptoms:

• A sensation of a mass protruding from the anus.
• A clearly noticeable and palpable reddish and fleshy mass extending out of the anus.
• This may be accompanied by some amount of mucosal discharge from the anus.
• Itching around the anal area.
• Bleeding.
• Initially, the rectum protrudes out only during bowel movements. As time passes, however, it starts happening more frequently and may even protrude when the patient is standing upright or walking.
• Passing small quantities of stools.
• Incomplete bowel movements.

Could There Be Any Complications?

Other problems may arise as a result of untreated rectal prolapse. Initially, it may be possible for the patient to push the prolapsed rectum back into position with the fingers. However, when the condition worsens, the rectum tends to easily slide out of position and out of the anus. As a result, the patient risks developing infections.

The exposed rectal tissue is also prone to injury and there may be some amount of bleeding. It is also possible for the patient to develop fecal incontinence as a result of complete rectal prolapse. This can be distressing, inconvenient and embarrassing to the patient. On account of this condition, the patient may feel embarrassed to go out of the house or engage in normal activities.

How Is Rectal Prolapse Diagnosed And Treated?

When a patient feels that part of the rectum is beginning to protrude through the anus, they should consult their doctor and not defer consultation until the situation gets worse and unmanageable. It is possible to mistake external hemorrhoids for rectal prolapse. So, the best course of action is to get a formal diagnosis.

The doctor will begin by carrying out a physical examination of the patient. If the rectum is visibly protruding from the anus, the problem is immediately apparent. In other cases, digital rectal examination and imaging tests such as a colonoscopy may be required for clarity. The patient’s medical history is relevant, too, in case they have a history of multiple pregnancies or a medical problem like cystic fibrosis.

The most important step is to ascertain the cause of the problem so that it can be treated effectively. Depending on other symptoms displayed by the patient, the doctor may order more tests such as blood investigations to identify infections or undiagnosed chronic conditions like diabetes.

Prevention

As the adage goes, prevention is better than cure. This is certainly true in the case of rectal prolapse. If you have any of the risk factors for this condition or feel that you may already have developed a mild prolapse, you can take steps to prevent it from occurring or worsening, as the case may be. If your problem is constipation, then make sure to consult a doctor on the best methods to alleviate it. This may involve dietary modifications and taking stool softeners to ease the passage of feces without the straining that can lead to rectal prolapse.

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