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Rectal prolapse

Rectal prolapse is when part of your rectum (back passage), or the lining of your rectum, protrudes through your anus.

Your rectum is the last part of your digestive system. Food passes through your small bowel (the longer, thinner part of your bowel) and nutrients are absorbed. Food waste then travels through your large bowel where it becomes solid faeces. Your rectum, at the end of your large bowel, is where faeces collect before passing through your anus as a bowel movement.

Your rectum is made up of three layers and includes:

  • the rectal wall lining (mucosa)
  • a layer of muscle (muscularis propria)
  • fatty tissue surrounding the rectum (mesorectum)

Rectal prolapse occurs when the wall of your rectum, or part of its lining, protrudes through your anus. This may happen when you're having a bowel movement. However, it can also happen when you cough or sneeze, or even when you're doing everyday activities, such as walking or standing up.

Rectal prolapse mainly affects women – it's most common in women aged over 50. However, it can happen at any age and also affects men. Young children (usually under three) may also get rectal prolapse and it affects girls and boys equally.

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Image showing the large and small bowels

Details

  • Types Types of rectal prolapse

    There are three main types of rectal prolapse.

    • Full-thickness rectal prolapse is when part of the wall of your rectum (including all three wall layers) protrudes through your anus.
    • Mucosal prolapse is when the lining of your rectum protrudes through your anus.
    • Occult or internal intussusception rectal prolapse is when your rectum folds in on itself but doesn't protrude through your anus.
  • Symptoms Symptoms of rectal prolapse

    The most obvious symptom of rectal prolapse is a lump or swelling coming out of your anus. Initially you may only have this when you have a bowel movement. However, as the condition develops it may also happen when you cough or stand up. If you have internal intussusception rectal prolapse, there may be no lump or swelling coming through your anus. However, you may feel as though something is still in your rectum after you empty your bowels.

    You may find that you’re able to push the lump back in using your fingers. However, it may become difficult and as soon as you push it back in, it may protrude out again. You might not be able to push it back in at all.

    If you have rectal prolapse, it can make it difficult for you to control your bowel movements. You may end up soiling your underwear or have a slimy discharge from your rectum. These symptoms can make it difficult for you to maintain good hygiene.

    You may have some bleeding from your rectum and discomfort in the area. You may also develop an ulcer on the prolapsed part of your rectum.

  • Diagnosis Diagnosis of rectal prolapse

    Your GP will ask about your symptoms and examine you. He or she may need to insert a finger inside your rectum to examine you. Your GP will wear gloves to do this. He or she may also ask you about your medical history.

    Your GP may be able to diagnose a rectal prolapse by examining you. He or she may refer you to a doctor who specialises in conditions that affect the bowel for further tests. These may include:

    • evacuation proctography –this is a type of X-ray or scan that shows your rectum and anal canal when you're having a bowel movement
    • sigmoidoscopy – this uses a thin tube with a light and camera at the end to allow a doctor to look at the inside of your rectum and bowel
    • colonoscopy – this uses a narrow, flexible, tube-like telescopic camera called a colonoscope to allow a doctor to look inside your large bowel
    • endoanal ultrasound- this uses a thin ultrasound probe to look at the muscles used for bowel control

    You may also need to have other tests to rule out any underlying conditions that may be causing your rectum to prolapse.

  • Treatment Treatment for rectal prolapse

    In the early stages of your condition, your doctor may advise you to eat plenty of fruit and vegetables and other foods that contain fibre. He or she may suggest you take bulking laxatives, such as Fybogel, to help you empty your bowels without straining. Your doctor will also advise you to drink enough water.

    In children, rectal prolapse usually gets better without any treatment. Your GP will give you advice on how to get your child into a regular bowel routine. Ensure your child has plenty of fruit and vegetables in their diet, as well as foods that contain fibre. Also ensure your child drinks enough water. Your GP will also advise you on how to push your child's rectum back into their anus when it prolapses.

    Occasionally, your doctor may recommend your child has an injection of a substance called a sclerosant to help destroy the prolapsed tissue or surgery. However, this is only considered if other treatments have not been successful. It will also depend on how old your child is and how serious their condition is.

    Surgery

    The only way to effectively treat a full-thickness rectal prolapse is to have surgery.

    There are different types of surgery, but each type falls into two broad categories. This depends on where your surgeon will make the cut to operate on you. Your surgeon will either make a cut in your abdomen (one cut or a number of smaller cuts), or around the prolapse itself. If around the prolapse, it's known as perineal surgery.

    Your surgeon will advise you on the best type of operation for you. It's important to remember that the rectal prolapse may come back after you have surgery by either method. The likelihood of a successful operation will depend on the type of surgery you have and your individual circumstances. Ask your surgeon for more information.

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  • Causes Causes of rectal prolapse

    The exact reasons why you may develop rectal prolapse aren't fully understood at present, but it’s often associated with weakened muscles in your pelvis. It’s known to be related to certain conditions that put extra pressure on your abdomen (tummy), such as:

    Rectal prolapse is also occasionally related to neurological conditions, including:

    In older women, rectal prolapse can occur at the same time as a prolapsed womb or bladder. This is thought to be due to a general weakness in your pelvic floor muscles. These are the group of muscles that form a supporting sling between your pubic bone and the base of your spine. This weakness in your pelvic floor muscles may be related to previous pregnancy and childbirth.

  • Complications Complications of rectal prolapse

    Although very rare, part of your rectum can become trapped. This can cut off the blood supply and cause the protruding mass of tissue to die (this is called strangulated prolapse). It can be extremely painful and may cause the prolapsed part of your rectum to swell. If this happens, you must seek urgent medical attention.

  • FAQs FAQs

    How common is rectal prolapse?

    Answer

    The exact number of people with rectal prolapse is difficult to estimate as many people with the condition may not tell their GP about it.

    Explanation

    Rectal prolapse is a condition that’s often under-reported. This is because many people who have it don't tell their doctor about it, especially those who are older. Rectal prolapse in adults most commonly affects women over 50.

    Rectal prolapse can also affect children. However, this is fairly uncommon and normally only affects children under the age of three.

    If you or your child has a rectal prolapse, it's important to see your GP. If you don't get treatment, rectal prolapse can lead to bleeding and incontinence. If you have a severe prolapse, it can get strangulated. A strangulated prolapse is when parts of your rectum become squashed, cutting off the blood supply and causing the protruding mass of tissue to die. If this happens, you must seek urgent medical attention.

    In children, rectal prolapse usually gets better on its own without treatment once your child has developed good bowel habits. In adults, surgery is often the only option to correct a prolapsed rectum.

    If you have any further questions or concerns about rectal prolapse, talk to your GP.

    How long does it take to recover after surgery to treat rectal prolapse?

    Answer

    The length of time it will take you to recover after surgery to treat rectal prolapse will depend on the type of operation you have. It will also depend on your general health. It's important to remember that our bodies are all different and we all heal at different rates.

    Explanation

    There are two different types of procedure that are used to treat rectal prolapse: abdominal procedures and perineal procedures. The operation will involve your surgeon either making a cut in your abdomen (one cut or a number of smaller cuts), or around the prolapse itself. Your surgeon will advise you on the most suitable type of operation for you.

    Generally, people who have a perineal procedure have less pain and usually spend less time in hospital (one to three days). This compares to three to seven days for those having an abdominal procedure. However, if your surgeon uses keyhole surgery on your abdomen, it may take less time to heal.

    How long it will take you to fully recover from your operation will very much depend on your individual circumstances. Talk to your surgeon about what to expect before you have your operation.

    What's the difference between rectal prolapse and piles?

    Answer

    Rectal prolapse and piles (haemorrhoids) are both conditions that affect the last section of your bowel. Rectal prolapse affects the rectal wall or lining, whereas piles affect the blood vessels in your anal canal. However, both conditions can have similar symptoms. It's important to get the right diagnosis from your GP or specialist as the treatment for each differs.

    Explanation

    Rectal prolapse is when the wall of your rectum or part of the wall protrudes through your anus. The rectum is the last section of your bowel where faeces collect before passing through your anus as a bowel movement.

    Piles are round swellings on the inside of the anal canal in areas known as the anal cushions. The anal canal is the short section that connects your rectum with your anus. The swellings are caused by swollen blood vessels in the anal cushions.

    Both conditions may cause a lump or mass of tissue to drop out through your anus when you have a bowel movement. With piles, the mass will normally be smaller but it’s possible to mistake large piles for a rectal prolapse and vice versa. In both conditions, the tissue may go back in again once you've finished your bowel movement. But for some people, it may be necessary to push the mass back inside. You may also have some bleeding and pain when you have a bowel movement, as well as a slimy discharge that may soil your underwear.

    The conditions do differ in the groups of people they affect. Rectal prolapse mainly affects older people, especially women and sometimes young children under the age of three. Piles can affect people at any age but are most common in people between 45 and 65.

    It's important to get a diagnosis from your GP early to prevent any complications or your symptoms getting worse.

    You can treat piles with self-help measures, such as increasing the amount of fibre in your diet and drinking enough water. You can also buy medicines or have banding treatment or surgery. In adults, rectal prolapse can usually only be treated effectively with surgery. In children, rectal prolapse usually gets better after they get into a good bowel habit. You can ensure this by giving your child plenty of fruit and vegetables in their diet and making sure they eat foods that contain fibre. Also make sure your child drinks enough water.

    If you have any questions or concerns about rectal prolapse or piles, talk to your GP.

  • Resources Resources

    Sources

    • Rectal prolapse. Medscape. www.emedicine.medscape.com, published 17 May 2013
    • Rectal prolapse. Bowel and Cancer Research. www.bowelcancerresearch.org, accessed 29 July 2013
    • Rectal prolapse. Better Health Channel. www.betterhealth.vic.gov.au, published March 2012
    • Rectal prolapse. American Society of Colon and Rectal Surgeons. www.fascrs.org, published 2012
    • Pediatric rectal prolapse treatment and management. Medscape. www.emedicine.medscape.com, published 20 May 2013
    • Hemorrhoids. Medscape. www.emedicine.medscape.com, published 12 September 2012
    • Hemorrhoids: expanded version. American Society of Colon and Rectal Surgeons. www.fascrs.org, published 2011
  • Related information Related information

  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, October 2013.

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