Rectal prolapse
- Professor Humphrey Scott, Consultant general surgeon
- Mr Henry Dowson, Consultant general surgeon
- Kristina Routh, Freelance Health Editor
Key points
- Symptoms of rectal prolapse include a lump or swelling coming out of your anus, constipation, straining to pass bowel movements and feeling discomfort or pain.
- Rectal prolapse is most common in women over 60 and young children under three. But people of any age can get it.
- Rectal prolapse usually gets better by itself in young children without treatment. But adults usually need surgery for rectal prolapse.
What is a rectal prolapse?
A rectal prolapse is when the end of your bowel (your rectum) slides out through your anus (back passage). This forms a lump. At first, you may only get the rectal prolapse when you're having a bowel movement. But eventually it might be there all the time.
Having 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 risk factors 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
- an enlarged prostate
- weakened pelvic floor muscles
Rectal prolapse is also occasionally linked to neurological (nerve) conditions, including:
- multiple sclerosis (MS)
- lumbar (low back) disc disease
- an injury to your lower back or pelvis
- spinal tumours
Types of rectal prolapse
There are three types of rectal prolapse.
- Full-thickness (complete) rectal prolapse. This is when the entire thickness of the wall of your rectum slides out.
- Partial or mucosal prolapse. This is when just the lining (mucosa) of your rectum slides down inside your rectum and comes out.
- 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.
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
- are walking or standing 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
- constipation – feeling like you’re unable to have a poo
- having bright red blood coming from your rectum
- slimy mucus coming from your rectum, which can be constant
- feeling some discomfort or pain
These symptoms might not be a rectal prolapse. So if you have symptoms, contact your GP.
What should I do if I'm embarrassed to talk to my doctor?
Seeing a doctor when you're embarrassed | Watch in 2:08 minutes
Dr Naveen Puri talks about how to make it easier to see a doctor about a health issue when you are feeling embarrassed.
Hello, I am Dr Naveen Puri, I am one of the GPs within Bupa Health Clinics.
Today I want to speak to you about embarrassing problems you might have and what we can do if you attend one of our clinics.
I want you to know that many people feel embarrassed or concerned about speaking about certain things with their doctors, but I'm here to reassure you these are the kinds of things we deal with every day.
For me, looking at someone's bottom or their breasts or their genitalia is no different to looking at their nose or elbow.
And that's true for all doctors as we train for many years in these parts of the body and are very used to having these conversations with people just like you.
So what I would encourage you to do if you have any concerns from your perspective, be it a change in your bowel habit, be it a lump, a rash, a swelling. Something on your genitalia or a part of your body you're not particularly familiar with or feel uncomfortable discussing.
Please be assured your doctor has done it all before.
Some of the ways we find patients find it easier to speak to a doctor is to either tell the doctor you feel embarrassed up front. That way a doctor can make extra effort to make sure you feel comfortable.
Or some patients come to us with pieces of paper and will write the problem down and hand it to us. That way we can help with whatever is going on for you as well.
You may also find it helpful to ask for a specific doctor, someone you're familiar with in your practice. Or you might want to ask for a doctor of a specific gender, or background to your liking as well.
I'd also say, doctors do this every day so don't be alarmed if we ask you certain questions around your symptoms. It is purely so we can help you get the best outcome for your enquiry.
And then finally, feel free to use language that suits you as well. We don't expect you to know the medical words for things, or a name for your diagnosis. That's our job to find out for you.
So, take your time, see a doctor, and hopefully we can help put your mind at ease.
Diagnosis of rectal prolapse
Your GP may be able to tell that you have a rectal prolapse from your symptoms. But, they will probably want to examine your bottom and do a rectal examination too.
How do doctors test for prolapse?
Your GP may ask to carry out 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.
- Colonoscopy or flexible sigmoidoscopy. Your doctor uses a narrow, flexible, tube-like camera (a colonoscope) to look inside your large bowel.
- CT (virtual colonoscopy). This scan assesses the lower bowel. Air is pumped into the bowel and a CT scan performed to check the lining of the bowel.
- Proctography (defecography). This is a type of X-ray that shows your rectum and anal canal when you're having a bowel movement.
- Rigid proctosigmoidoscopy. This uses a rigid tube with a light to look at the inside of your rectum.
- Other tests that look at how the muscles or nerves around your anus are working – for example, an anal manometry.
- Other tests may include a CT scan of your abdomen (tummy) 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.
If your doctor recommends you have any of these tests, they’ll explain how the test may help and what is involved.
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Management of rectal prolapse
The best treatment for rectal prolapse depends on the type of prolapse you have, as well as other things like your age and your overall health.
Can rectal prolapse go away on its own?
In young children, a rectal prolapse usually gets better by itself, without any specific treatment. But adults usually need an operation to fix a rectal prolapse.
Can you push a prolapse back in?
Your doctor may gently push the prolapse back in. They may show you how to do this yourself too.
Pushing a rectal prolapse back in needs to be done very gently. You need to try and relax (or encourage your child to relax) while you’re doing it. You’ll probably find it easier to do while lying on your back or side, rather than sitting or squatting. Press gently and steadily on the prolapsed tissue to help it go back inside through the anus.
Your doctor may advise you to use a little lubricating jelly to help it slide back in more easily.
Can you reverse rectal prolapse symptoms without surgery?
There are certain things you can do before or instead of surgery, to help manage your symptoms, as well as reducing your prolapse. These measures are often enough to manage a partial prolapse.
- Treating constipation or diarrhoea. For constipation, this includes eating more high-fibre foods and making sure you’re drinking enough. Try not to strain when you have a bowel movement. Your doctor may also prescribe a laxative to soften your poo.
- Barrier creams. Your doctor may also recommend that you use barrier creams containing zinc – for example, baby nappy rash creams – around your anus.
- Exercises. Your doctor may also suggest doing specific exercises to strengthen your pelvic floor muscles and prevent the prolapse getting worse They may refer you to a physiotherapist who has an interest in the pelvic floor.
What happens if a rectal prolapse is left untreated?
If left untreated, a rectal prolapse is likely to get larger and come out more easily. Symptoms such as incontinence (losing control of your bowels) will keep getting worse. And the longer you leave it before having treatment, the more likely it is that your prolapse will return afterwards. So, if you have a rectal prolapse, contact your GP.
Surgery for rectal prolapse
In adults, it’s unlikely that a full-thickness rectal prolapse will go away on its own. Surgery might sometimes be recommended for a partial relapse too. Children may need surgery if they have a complicated rectal prolapse or if their prolapse hasn’t gone away within a year.
What happens before surgery for rectal prolapse?
If your surgeon recommends you have an operation, they’ll explain what this involves and how you should prepare. They will 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 operation procedure for rectal prolapse?
There are many different procedures which surgeons can use to treat a rectal prolapse.
Surgery for rectal prolapse is carried out in one of the following two ways.
- Through your abdomen (tummy). This involves making a cut in your abdomen to reach your rectum and fix it in place (rectopexy). Younger patients usually have this type of surgery. It is usual to have this done with keyhole (laparoscopic) surgery.
- Through your perineum (the area around your anus). It can involve removing part of the prolapsed rectum and sewing 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).
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 will 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 one in five people who have surgery for a rectal prolapse.
Complications of rectal prolapse
If a rectal prolapse isn’t treated, it can go on to cause complications. These may include the following.
- Ulcers forming 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 gets cut off. This is very unusual, but if it happens, you may no longer be able to push your prolapse back in. You must seek medical advice straightaway if this happens because you’ll need surgery.
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Constipation
Constipation is a common condition that affects your usual pattern of bowel movements.
Piles
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