Washington University Colon and Rectal surgeons answer patient questions regarding rectal prolapse.
The rectum is normal fixed inside the body and is connected to the anal canal. Rectal prolapse is a condition where the connections that hold the rectum inside weaken and the rectum can fall through the anus. Rectal prolapse may be associated with drainage of mucus, blood or stool, fecal incontinence, and can often times be uncomfortable or very painful. Rectal prolapse may happen as a result of straining on the toilet but can occur with very little pressure at random times.
Rectal prolapse effects approximately 2.5 out of 100,000 people. While this is a relatively rare condition, it is a very common issue treated at Washington University in St. Louis. This problem is more frequent in women and tends to occur in patients over the age of 60, however, men and women of all ages can experience this problem.
The exact cause of rectal prolapse is unknown but many factors can contribute to creating this problem. Patients who have rectal prolapse have lost the normal attachments around their rectum that hold it into place. Many patients who experience this problem also have issues with constipation and straining. It may be associated with weakened pelvic floor muscles which can be a result of childbirth of aging. Rectal prolapse may be related to genetics (run in families). It can also be related to psychiatric conditions or medical problems such as collagen vascular disorders.
Rectal prolapse can typically be seen by examining the anal canal when you feel the rectum has fallen out from the normal position. This is usually most obvious after bowel movements and straining. The rectum may be able to be seen outside of the anus but sometimes the rectum will return back inside once straining stops. You may feel a bulge outside of the anus and it will look like a red or pink mass outside the anal canal. It is very hard to tell the difference between rectal prolapse and very enlarged hemorrhoids. If you have concern for either issue, please see a colorectal surgeon for a detailed evaluation.
Rectal prolapse is often treated with surgery but if symptoms are not bothersome or surgery is not safe, patients can avoid an operation. If patients choose not to undergo surgery, the prolapse will typically not get better and may often times get worse as time goes on. Symptoms of prolapse such as the bulge, pain, bleeding and incontinence can all progress over time as the pelvic floor and anal muscles weaken with age and ongoing stretch from the prolapse.
Non-surgical therapies may help some of the symptoms from rectal prolapse but will not fix the prolapse itself. This includes dietary and lifestyle changes, medications, work with a pelvic floor physical, and learning how to reinsert (reduce) the prolapse back into the anus to relieve pressure.
There are multiple surgical options that are safe and effective for patients of all age and fitness. The choice of which procedure to offer is based on the safest option for the patient. This is determined on the patient’s medical problems, previous surgeries, and safety of anesthesia. Surgery may be done with or without mesh. Sometimes, removing part of the colon to help with constipation is needed. If there are issues with prolapse of the vagina or bladder, your colorectal surgeon will recommend a specialist who fixes these issues (a urologist or a urogynecologist) to discuss combination surgery to fix both issues at the same time.
Washington University Colon and Rectal can provide care and treatment options for rectal prolapse. Meet our specialists below.