Types of rectal prolapse
There are three types of rectal prolapse.
- Full-thickness rectal prolapse is when part of the wall of your rectum sticks out through your anus. This is the most visible type of rectal prolapse and so is the type of prolapse patients most commonly see their doctor about.
- Mucosal prolapse is when only the lining (mucosa) of your rectum sticks out through your anus.
- Internal rectal prolapse is when your rectum folds in on itself but doesn't stick out through your anus. This is also known as an internal intussusception.
People of any age can get a rectal prolapse. However, it’s most common in women older than 60, and in young children under three.
Symptoms of rectal prolapse
If you have a rectal prolapse, you’re likely to notice a lump or swelling coming out of your anus. At first, you may only notice this when you have a bowel movement. But if your prolapse gets worse, this may also happen when you cough, sneeze or stand up.
Other symptoms may include:
- finding it difficult to control your bowel movements. You may find you’ve passed some faeces (motion) when you didn’t mean to
- having some bright red blood or slimy mucus coming from your rectum
- feeling some discomfort or pain
You may be able to push any lump or swelling back in by using your fingers. But this may become more difficult, and the lump may stick out again as soon as you push it back in. Eventually, you may not be able to push it back in at all.
If you have an internal rectal prolapse you may feel as though you’re not fully emptying your bowels, rather than noticing a lump. See our previous section for a description of internal rectal prolapse.
If you think you may have a rectal prolapse, contact your GP.
Diagnosis of rectal prolapse
Your GP may be able to diagnose a rectal prolapse by asking about your symptoms and examining you. They’ll need to examine your anus (back passage) and the area around it. You may need to stand up or squat and strain (as if you were having a bowel movement) while they examine you.
Your GP will carry out a rectal examination. This will involve them gently inserting a gloved, lubricated finger inside your rectum. 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.
Your GP may refer you to a colorectal surgeon, a doctor who specialises in conditions that affect the bowel. You might need further tests, which may include the following.
- Colonoscopy – this uses a narrow, flexible, tube-like telescopic camera called a colonoscope to allow a doctor to look inside your large bowel.
- Barium enema – this is an X-ray examination of your lower bowel. A special fluid is passed through your anus to show up the lining of your bowel when X-ray pictures are taken.
- Proctography – this is a type of X-ray or MRI scan that shows your rectum and anal canal when you're having a bowel movement. This test is also known as defecography.
- Rigid proctosigmoidoscopy – your doctor uses a non-flexible tube with a light to look at the inside of your rectum.
Your doctor may recommend other tests, in which case they’ll explain what they are and why they may help. For instance, they may suggest tests to see whether your rectal prolapse has an underlying cause, such as nerve damage.
If your doctor recommends a particular test, they’ll tell you what it involves and how you need to prepare. If you have queries or concerns, feel free to ask.
Treatment for rectal prolapse
If you think you, or you child has a rectal prolapse you should contact your GP. The best treatment for you will depend on your age, your overall health and what’s caused the prolapse in the first place.
In young children, especially those under three, rectal prolapse usually gets better without any specific treatment. Your doctor may show you how to push the prolapse back in safely.
If your child is constipated, your doctor may give you advice on how to help your child to have bowel movements more regularly. Make sure they eat plenty of fruit and vegetables, as well as other high-fibre foods, and drink enough. They should go to the toilet regularly to empty their bowels, but without straining to pass stools. Your doctor may recommend a mild laxative for them.
In some cases an injection of a substance called a sclerosant inside the anus can help. This aims to stick the rectum in place so it doesn’t prolapse. If your doctor recommends this for your child, they’ll explain why, and what’s involved. If other treatments don’t work, your child may need surgery (see below). This will also depend on how old your child is and how serious their prolapse is.
Although rectal prolapse in children can get better without treatment, around one in 10 children continue to have a rectal prolapse into adulthood.
To start with, your doctor may recommend that you treat any constipation. This means eating plenty of foods that contain fibre. High-fibre foods include fruit and vegetables, and wholegrain cereals. Laxatives that make your stools softer will help you empty your bowels without straining. You should also make sure you drink enough water. You can get a lot more information from our topic on constipation.
Your doctor can show you how to safely push your prolapse back in. They may recommend that you use barrier creams around your anus as the mucus from the prolapse can be irritating. They may also suggest specific exercises you can do to strengthen your pelvic floor muscles.
In adults, it’s unlikely that a rectal prolapse will go away on its own. If you have only a mucosal (lining) prolapse, your doctor may recommend treatment with sclerosant injections to stick the mucosa in place. Some adults with a rectal prolapse need surgery.
Rectal prolapse surgery
There are many different procedures which surgeons can use to treat a rectal prolapse. Which type of surgery is best for you will depend on several different things. These include the type of prolapse you have, your age and whether you have any other medical problems. It also depends on whether or not you have a problem with constipation.
There are two main types of surgery for rectal prolapse.
- Abdominal surgery involves making a cut (or several cuts) in your abdomen (tummy). This usually means your surgeon lifts up your rectum and fixes it in place (rectopexy) so that it doesn’t prolapse again. There are various ways to do this. It may be an option for you to have this done with keyhole (laparoscopic) surgery. For this, instruments are passed through tiny cuts in your abdomen.
- Perineal surgery involves carrying out the surgery through your perineum, the area around your anus, rather than the front of your abdomen. There are several types of perineal surgical procedure which your surgeon can perform to help stop your rectal prolapse happening again. This type of surgery may be used if you’re not fit enough for the more major abdominal surgery.
Doctors are still trying to decide which procedures are best for treating rectal prolapse. If you have abdominal surgery rather than perineal surgery, you may be less likely to have another prolapse afterwards. But you may be more likely to have complications after surgery, such as bleeding.
One in five people who have surgery for a rectal prolapse have another prolapse at some point.
Your surgeon will discuss with you which is likely to be the best type of operation in your particular circumstances.
Causes of rectal prolapse
Doctors don’t fully understand why some people get a rectal prolapse. It’s often linked to weak muscles in your pelvis.
Anything that increases the pressure inside your abdomen can increase your risk of getting a rectal prolapse. This includes:
- constipation and/or straining when you have a bowel movement
- conditions that make you cough a lot, such as cystic fibrosis, chronic obstructive pulmonary disease (COPD) or whooping cough
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
In older women, rectal prolapse can happen at the same time as a prolapsed uterus (womb) or bladder. This is thought to be caused by a general weakness in your pelvic floor muscles. Your pelvic floor is the supportive sling of muscles and ligaments that keep all your pelvic organs in place. The muscles of your pelvic floor may become weak after you have a baby.
Complications of rectal prolapse
If a rectal prolapse isn’t treated, it can sometimes cause complications. These may include:
- ulcers on the lining (mucosa) of your rectum where it sticks out. The ulcers themselves won’t be painful, but you may notice a bloody discharge which makes your skin sore. Having these ulcers may be one reason why a child with rectal prolapse may need surgery.
- death of the tissue of your rectum that has prolapsed. This condition is rare, but it can happen if the prolapse gets trapped and its blood supply gets cut off. If this happens, you must seek medical advice straightaway, as you’ll need surgery.
If you have surgery for a rectal prolapse your surgeon will discuss any possible complications, and how likely these are to happen. The most common complications after surgery are bleeding and breakdown of the tissues where two bits of your bowel are stitched together.
FAQ: How common is rectal prolapse?
Many people don’t tell their GP about their bowel symptoms, so it’s difficult to know for certain how common rectal prolapse is. However, doctors think it’s probably quite rare – perhaps around one in 200 people have it.
In adults, rectal prolapse is most common in the elderly. And it’s six times more common in women than in men. In children, rectal prolapse is most likely to happen before the first birthday. After that it becomes less and less common. Unlike in adults, girls and boys seem to get it about equally.
FAQ: Should I push the prolapse back in myself?
If you have a rectal prolapse, it may go back inside by itself, for instance after you have finished emptying your bowels. In most cases in a child the prolapse goes back in when they stop squatting. But the prolapse may not go back in without help. You may find that you need to push it back in yourself. Your doctor will let you know if this is OK for you to do, and can tell you how to do it safely. Always follow your doctor’s advice.
Pushing a rectal prolapse back in needs to be done very gently. You may want to wear gloves. Press gently and steadily on the prolapsed tissue to help it go back inside through the anus (back passage). Your doctor may advise you to use a little lubricating jelly to help it slide back in more easily. Never push hard. If it is painful, stop and seek medical attention.
If the prolapse won’t easily go back in, your doctor may suggest that you apply some ordinary granulated sugar to it. Leave the sugar on for 15 minutes before gently pushing again. The sugar helps draw out extra water from the prolapse to make it shrink. Don’t use a sugar substitute as this won’t work.
If the prolapse won’t go back in, is painful, or you notice dark or bluish-purple tissue, you should seek medical attention as soon as possible. Don’t keep trying to push it back or you may cause damage to the wall of your bowel.
FAQ: How long does it take to recover after surgery?
How long it will take you to recover after surgery for rectal prolapse will partly depend on the type of operation you have. It will also depend on your general health.
Your doctor can treat rectal prolapse with two different types of surgery – see our treatment section above for details.
If you have perineal surgery, you’ll usually have only a moderate amount of pain after the operation. You can usually eat again after 12 to 24 hours. You’ll start with liquid food, but move to normal solid foods as soon as possible. You’ll usually be able to leave the hospital within three days.
If you have abdominal surgery, you usually spend three to seven days in hospital. You’re likely to have more pain than if you had perineal surgery and it will take you longer to eat normal food. However, if you have laparoscopic (keyhole) abdominal surgery, your hospital stay may be shorter and you may have less discomfort afterwards.
Everyone’s recovery is different – it may take four to six weeks to feel fully recovered. You can resume your usual activities when you feel ready but follow any advice your surgeon gives you. Your surgeon will let you know if you should restrict some activities, such as lifting and strenuous exercise, and for how long. This may be for up to six weeks.
Your surgeon will stress how important it is to avoid getting constipated after your surgery. See our treatment section above for more information about this.
In the month following your surgery, you’ll usually see your surgeon once or twice. Your surgeon will check you have healed properly and that your bowels are working normally.
With all types of surgery for rectal prolapse, there’s a chance that you may have another prolapse. If you think you have another prolapse, see your GP straightaway.
FAQ: What's the difference between rectal prolapse and piles?
Rectal prolapse and piles (haemorrhoids) both affect the last section of your bowel. Both conditions can cause similar symptoms, but they need to be treated in different ways.
If you have a rectal prolapse, the wall of your rectum, or part of the wall, sticks out through your anus. Piles are abnormally large swellings developing around blood vessels within the lining of your anal canal. The anal canal is the short section that connects your rectum to your anus.
Both a rectal prolapse and piles can cause a lump or swelling to drop out through your anus when you have a bowel movement. You may also notice bright red bleeding and pain or discomfort, as well as a slimy discharge on your underwear.
The two conditions affect different groups of people. Rectal prolapse affects mainly older people, especially women, and sometimes young children. Piles can affect people at any age but are most common in people between 45 and 65. They affect men and women equally.
Don’t be embarrassed to see your GP if you think you might have a rectal prolapse or piles. It's important to get the correct diagnosis so that you can start the right treatment.
For more information, see our topic on piles.
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- Personal communication, Mr Stephen Pollard, Consultant Surgeon, 2018
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