Rectal prolapse

What is a rectal prolapse?

A rectal prolapse is when the end of your bowel (your rectum) slides out through your back passage (anus). This forms a lump. At first, you may only get the rectal prolapse when you have a poo (bowel movement). You may be able to push it back in, but eventually it might be there all the time.

A rectal prolapse can be uncomfortable and interfere with your daily life. You may feel embarrassed about it, but it’s important to see your GP if you think you may have one.

Causes of rectal prolapse

It’s not clear exactly why some people get a rectal prolapse, but things that can include your risk of getting one include:

• having constipation for a long time, which makes you strain when you poo
• pregnancy
• diarrhoea
• conditions that make you cough a lot, such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), or whooping cough
• weakened pelvic floor muscles

Rectal prolapse is also occasionally linked to nerve (neurological) conditions, including:

• multiple sclerosis (MS)
• lumbar (low back) disc disease
• an injury to your lower back or pelvis

Types of rectal prolapse

There are three types of rectal prolapse.

• Internal rectal prolapse. This is when the lining of your rectum slides down inside your rectum but doesn't reach as far as your anus. This is also known as an internal intussusception.
• Partial or mucosal prolapse. This is when just the lining (mucosa) of your rectum slides down inside your rectum and comes out.
• Full-thickness (complete) rectal prolapse. This is when the entire thickness of the wall of your rectum slides out.

Symptoms of rectal prolapse

The most obvious symptom of rectal prolapse is having a lump or swelling coming out of your anus. At first, you may only notice this after you’ve had a poo. But if your prolapse gets worse, it may also happen when you:

• strain
• cough or sneeze
• walk or stand up

It may then end up being there all the time.

Other symptoms may include:

• being unable to control when you poo – you might not be able to hold it in until you reach the toilet
• feeling like you haven’t emptied your bowels fully
• bright red blood coming from your bottom
• slimy mucus or poo coming from your bottom
• feeling some discomfort or pain

These symptoms might not be a rectal prolapse. If you have symptoms, contact your GP.

Diagnosis of rectal prolapse

Your GP may be able to diagnose a rectal prolapse from your symptoms. But they’ll probably want to examine your bottom and do a rectal examination too.

How do doctors test for prolapse?

Your GP may ask to do a rectal examination to feel inside your back passage. A rectal examination can feel uncomfortable but shouldn’t hurt. Your GP will ensure your privacy, and you can ask to have someone with you during the test. Try not to feel embarrassed – your doctor really wants to help you.

Referral and further tests

If your GP thinks you have a rectal prolapse, they’ll usually refer you to a colorectal surgeon. This is a doctor who specialises in conditions that affect the bowel.

Your surgeon may recommend further tests to rule out other related health problems.

• Rigid proctosigmoidoscopy. In this test, your doctor will use a rigid tube with a light to look at the inside of your rectum.
• Colonoscopy or flexible sigmoidoscopy. Your doctor will use a narrow, flexible, tube-like camera (a colonoscope) to look inside your large bowel.
• CT (virtual colonoscopy). This is a scan to assess your lower bowel.
• Defecating proctogram (defecography). This is a type of X-ray that shows your rectum and anal canal when you're having a poo.
• Other tests may include a CT scan of your tummy (abdomen) and pelvis to check for other problems. You may also be offered an MRI scan of your pelvis to give more information about the prolapse. Your doctor may sometimes recommend tests that look at how the muscles or nerves around your anus are working, such as an endoanal ultrasound or ano-rectal physiology tests.

If your doctor recommends you have any of these tests, they’ll explain how the test may help and what’s involved.

Rectal prolapse surgery

In adults, it’s unlikely that a full-thickness rectal prolapse will go away on its own. Rectal prolapse surgery might sometimes be recommended for a partial relapse too. Children may need rectal prolapse surgery if they have a complicated rectal prolapse or if their prolapse hasn’t gone away within a year.

What happens before rectal prolapse surgery?

Your surgeon will explain what the operation involves and how you should prepare. They’ll explain all the benefits and possible risks of your surgery and complications, including the chance that the prolapse may come back. You can ask any questions you have to make sure you’re happy to give your consent to the treatment.

What is the procedure for rectal prolapse?

There are different procedures that surgeons can use to treat a rectal prolapse.

Rectal prolapse surgery is carried out in one of two ways.

• Through your tummy (abdomen). Your surgeon will make a cut in your tummy to reach your rectum and fix it in place (rectopexy). Younger patients usually have this type of surgery. It’s usual to have this done with keyhole (laparoscopic or robotic) surgery.
• Through your perineum (the area around your anus). Your surgeon may remove part of the prolapsed rectum and sew in place the remaining section to prevent it happening again.

If you have a partial (mucosal) prolapse, your surgeon will use different techniques to treat it. The surgery is usually like the kind of surgery you might have for piles (haemorrhoids).

What happens after rectal prolapse surgery?

After surgery through your tummy, you’ll likely have some pain but your hospital team will help to manage this. They’ll give you fluids through a drip until you’re able to go to the toilet normally. As you recover, you can start to eat. Depending on the type of operation you had, you might need to eat a low-fibre diet for around two to three weeks before you start a high-fibre diet. But ask your surgeon for information specific to you. You may have a catheter for several days to help you pee. And you’ll need to stay in hospital for around three days to a week but ask your surgeon how long you’ll need to stay.

If you had surgery through your perineum, you’ll usually have less pain compared to tummy surgery. And you’ll have a shorter time in hospital – around one to three days, but check with your surgeon. Usually you’ll need to wait 12 to 24 hours before you can eat or drink anything. You can then drink and get back to a regular diet. Your bowel function should quickly return to normal.

How long does it take to recover from rectal prolapse surgery?

How long it will take to recover from surgery depends on many things, including the type of operation you had and your general health. In general, you’ll recover more quickly from perineal surgery than abdominal surgery. But everyone is different. Your surgeon can answer any questions you have about likely recovery time.

It’s possible you may have another rectal prolapse after you’ve had surgery. This happens to around 1 in 5 people who have rectal prolapse surgery. If you have surgery yet still have discomfort, visit your GP to ask for help.

Complications of rectal prolapse

If you don’t get treatment for a rectal prolapse, it can go on to cause complications. These may include the following.

• Ulcers may form on the lining (mucosa) of your prolapsed rectum, which might bleed and make your skin sore.
• Incarceration and strangulation of the prolapse. This is when the prolapse gets trapped and its blood supply is cut off. This is very unusual, but if it happens, you may no longer be able to push your prolapse back in. Seek medical advice straightaway if this happens because you’ll need surgery.