Rectal prolapse, a condition where the rectum protrudes through the anal opening, can be both distressing and disruptive to one's quality of life. According to the American Society of Colon & Rectal Surgeons, however, the condition is somewhat rare and only affects about 0.5% of the population. Rectal prolapse is most common in women over the age of 50, and in fact women in this age group are six times more likely to develop the condition than men. As bothersome a condition it may be, though, there are fortunately a variety of treatments available that can fix the problem.

What Is Rectal Prolapse?

As noted, a rectal prolapse occurs when the final part of the rectum loses its normal attachments inside the body and protrudes through the anus. The rectum itself is the last section of the large intestine after the sigmoid colon and located near the sacrum at the base of the spine; the rectum’s main function is to serve as a temporary holding area for feces.

The lining of the rectum is similar to other organs along the gastrointestinal tract in that it is made up of a series of soft mucosal layers that can sometimes be turned inside out and protrude through the anal opening. A prolapsed rectum can manifest in many different ways, depending on how much of the rectum protrudes from the anal canal:

  • Internal: Technically known as internal intussusception, this type of prolapse happens when the rectum telescopes on itself but does not protrude outside the body. This type can vary from the entire circumference of the rectal wall prolapsing or only segments prolapsing.
  • Mucosal: A mucosal prolapse is where a part of the inner lining of the rectum prolapses and actually exits the body. The prolapsed tissue appears as a reddish or pinkish lump during bowel movements but retracts back into the body afterward.
  • External: An external prolapse refers to when the full thickness of the rectal wall protrudes through the anus. It presents as a noticeable bulge or mass outside the body, especially during bowel movements or when straining.

    What Causes Rectal Prolapse?

    While there are many different potential risk factors that can lead to rectal prolapse, there is no clearly defined universal cause. The primary issue across the various types, though, is a weakening of the muscles and other tissues that hold the rectal wall in place. Below are some factors that are known to have this weakening effect:

    • Pelvic floor muscles: One of the most common factors in the development of a prolapse is a weakening of the muscles that support pelvic organs like the large and small intestines. The pelvic floor muscles and ligaments play a crucial role in supporting the rectum, but weakness in these structures can result in a loss of support and make a prolapse more likely.
    • Chronic constipation: Chronic constipation is typically defined as having fewer than three bowel movements in a week for three months or longer. Because stool is often hard and dry in these circumstances, the person can be prompted to strain considerably to complete the act of defecation; this kind of regular straining, however, can weaken the muscles in the pelvic region, including those surrounding the rectum and anal sphincter.
    • Childbirth: Rectal prolapse is fairly common in women who have given birth to a child, especially when it has been multiple vaginal deliveries. The extended pressure of the fetus on the pelvic floor can cause perineal injury and weaken the muscles and ligaments that hold various organs in place.
    • Neurological problems: Conditions affecting the nerves that control the pelvic muscles can also make the development of a rectal prolapse more likely. An example of such a neurological condition is multiple sclerosis, but it can also include an injury to the spinal cord or any injury that causes nerve damage in the area.
    • Predisposition: There is evidence that some people have a genetic predisposition to develop rectal prolapse, so a family history of the condition can be an indicator. People are also more likely to develop the problem in general as they get older and muscles throughout the body tend to get weaker.
    • Cystic fibrosis: Cystic fibrosis is a genetic disorder that mainly affects the respiratory system, but it also can have an impact on the digestive system by impairing the ability of the pancreas to produce important enzymes. This in turn can cause malnutrition, which weakens both pelvic floor muscles and other supportive tissues.

    Symptoms of Rectal Prolapse

    Depending on the type of rectal prolapse, there are a number of signs and symptoms that may present in addition to the prolapse itself:

    • Protrusion: Undoubtedly the most noticeable symptom is the protrusion of the rectal tissue through the anal opening. Because of the type of tissue that lines the rectal wall, the protrusion typically looks red or pink; in fact because of this, the appearance of a prolapse is often confused with hemorrhoids.
    • Discomfort: It is also fairly normal for a rectal prolapse to cause pain or discomfort in the patient, particularly during bowel movements or while sitting down. People also often feel a sensation of pressure or bulging in the anus.
    • Incontinence: Fecal incontinence, or the inability to control bowel movements, is another common symptom. Even if there isn’t a total loss of bowel control, the difficulty may manifest as stool leakage or the sensation of incomplete defecation.
    • Bleeding: If a rectal prolapse lingers over time, the protruding lining can thicken and become inflamed; this can cause the build of mucus and rectal bleeding.

    Diagnosis and Treatment Options

    Rectal prolapse is somewhat unique as a health condition because it can often be diagnosed based purely on a physical exam and review of the patient’s medical history. But because a prolapse is connected to a number of other conditions, there are times when basic imaging studies are necessary; examples include an X-ray with a barium enema or a colonoscopy that is used to rule out other gastrointestinal problems. Also, anorectal manometry may be used to measure pressures in the rectum while defecography examines the mechanics of defecation.

    Although a rectal prolapse can resolve itself in some children, for adults it requires treatment from a healthcare professional. The type of treatment needed to fix the problem naturally varies from person to person based on the kind of prolapse and the overall health of the individual. Below are some of the most common approaches to treatment:

    • Lifestyle changes: For more mild cases, it may be possible to reverse course or prevent further prolapse by making lifestyle changes like increasing the amount of fiber in your diet; this prevents constipation and reduces the need for straining during bowel movements.
    • Medication: There are a number of over-the-counter and prescription medications that can improve the situation. Nonsteroidal anti-inflammatory drugs (NSAIDs), for example, can reduce inflammation and pain, and stool softeners and laxatives can make bowel movements much easier to pass.
    • Rectopexy: In severe cases where most or all of the rectum has prolapsed, surgical treatment may be necessary. The rectal surgeon’s first choice is usually laparoscopic rectopexy, a procedure that involves securing the rectum to the surrounding structures to prevent further prolapse.
    • Altemeier procedure: One of the other types of surgery that is called for in severe cases involves the resection of part of the rectum. The procedure, known as the Altemeier procedure, involves removing part of the rectum and then reattaching the remaining sections.
    • Delorme's procedure: This procedure involves removing some of the excess rectal lining and reinforcing the remaining rectal wall.

    Contact Cary Gastro

    Rectal prolapse isn’t necessarily a very dangerous condition, but it can cause a number of additional problems if left untreated. But even if it isn’t very serious, it can cause pain, discomfort, and emotional distress. At Cary Gastro, our highly qualified team of healthcare providers is dedicated to providing the kind of digestive healthcare that brings both healing and improvements to quality of life. To speak with a gastroenterologist about any of your symptoms, please contact us today to request an appointment.