• Rectal Prolapse

    (Mucosal Prolapse; Partial Prolapse; Complete Prolapse; Internal Prolapse)

    Definition

    Rectal Prolapse
    Rectal prolapse
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The rectum is held in place by ligaments and muscles. When these become weak, rectal prolapse occurs.

    Risk Factors

    These factors increase your chance of rectal prolapse. Talk to your doctor if you or your child has any of these risk factors:
    • Age: more common in children aged 1-3 years and in older adults (especially women after menopause)
    • For children:
      • Cystic fibrosis
      • Previous anal surgery
      • Malnutrition
      • Straining during bowel movements
      • Infections
      For adults:
      • Straining during bowel movements
      • Pregnancy and the stress of childbirth
      • Weakness of pelvic floor muscles due to aging
      • Hemorrhoids

    Symptoms

    If you have any of these, do not assume they are due to rectal prolapse. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
    • Fecal incontinence (inability to control bowel movements)
    • Bleeding or mucous from the anus
    • Constipation
    • Feeling of incomplete bowel movements
    • Loss of urge to defecate
    • Anal pain or itching
    • Tissue that sticks out of the anus
    • Pain during bowel movements

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:
    • Examination of the anus and rectum
    • Defecography—series of x-rays of the rectum and anus taken during a bowel movement
    • Anorectal manometry—measures the strength of the anal sphincter muscles, sensation in the rectum, and the reflexes needed for normal bowel movement
    • Colonoscopy —visual exam of the rectum and colon (large intestine) using a flexible tube with a tiny camera on the end

    Treatment

    Prolapse in children tends to go away on its own. In adults, gentle pressure to the rectum can sometimes push the rectum back into place. The sooner the condition is treated, the better the outcome. Talk with your doctor about the best plan for you.

    Medicines

    Certain medicine may help to reduce pain and straining during bowel movements. Your doctor may recommend stool softeners and bulk agents, such as:
    • Sodium docusate (eg, Colace)
    • Psyllium (eg, Metamucil, Fiberall)
    • Methylcellulose (eg, Citrucel)

    Surgery

    In some cases, surgery may be needed. Surgeries used to treat rectal prolapse include:
    • Laparoscopic rectopexy—A laparoscope (a tiny camera) is placed through a small incision in the abdomen. The rectum is secured in place with stitches.
    • Perineal proctectomy—An incision will be made in the rectum. Tissue that is sticking out of the anus is removed.

    Prevention

    To help reduce your chance of rectal prolapse, take the following steps:
    • Eat a healthy diet that is high in fiber .
    • Exercise regularly.
    • To train your bowels, create a routine. For example, try to go to the bathroom after lunch each day.
    • Do not rush when moving your bowels.
    • If you feel the urge to defecate, go to the bathroom.

    RESOURCES

    American Gastroenterological Association http://www.gastro.org/

    American Society of Colon and Rectal Surgeons http://www.fascrs.org/

    CANADIAN RESOURCES

    Canadian Society of Intestinal Research http://www.badgut.com/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Constipation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated January 30, 2010. Accessed February 1, 2010.

    Professional Guide to Diseases . 9th ed. Ambler, PA: Lippincott, Williams, & Wilkins; 2008:294-295.

    Revision Information

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