About rectal prolapse
Your rectum is the last part of your digestive system, at the end of your large bowel. It’s where faeces (stools) collect before they pass through your anus as a bowel movement.
The wall of your rectum is made up of three layers, which are:
- the rectal wall lining (mucosa)
- a layer of muscle (muscularis propria)
- fatty tissue surrounding your rectum (mesorectum)
If the wall of your rectum or part of its lining, sticks out through your anus, this is called a rectal prolapse. It can happen when you're having a bowel movement. But you may also notice it when you cough or sneeze, or even when you're doing everyday activities, such as walking or standing up.
Rectal prolapse is common in children, usually before the age of four. It affects girls and boys equally. Adults can also develop rectal prolapse, especially women over 60.
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 common type of rectal prolapse.
- 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.
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.
If you have an internal intussusception rectal prolapse (when your rectum folds in on itself but doesn't stick out through your anus), you may not have a lump or swelling at all. But you may feel as though you’re not fully emptying your bowels. You may also pass some mucus.
You might also:
- find it difficult to control your bowel movements
- have some bright red blood coming out of your rectum
- have some discomfort
- develop an ulcer on the part of your rectum that sticks out
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.
Diagnosis of rectal prolapse
Your GP may be able to diagnose a rectal prolapse by asking about your symptoms and examining you.
You will need to have a rectal examination. This will involve your GP inserting a gloved, lubricated finger inside your rectum. You may need to stand up or squat and strain (as if you were having a bowel movement) during the examination. A rectal examination can be uncomfortable but shouldn’t be painful. You may feel like you need to empty your bowels afterwards.
You might need further tests, which may include the following.
- Proctography – this is a type of X-ray or scan that shows your rectum and anal canal when you're having a bowel movement.
- Flexible sigmoidoscopy – this uses a thin, flexible 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 you use to control your bowels.
You may also need to have other tests to see whether your rectal prolapse has an underlying cause, such as nerve damage.
Treatment for rectal prolapse
The best treatment for you will depend on your age, your overall health and what’s caused the prolapse in the first place.
Some adults with a rectal prolapse need surgery, but 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. You may also be offered bulking laxatives, such as Fybogel, which help you empty your bowels without straining. Your doctor may also advise you to drink enough water.
In children (especially those under four), rectal prolapse usually gets better without any specific treatment. Your doctor maygive you advice on how to get your child to have bowel movements more regularly. Make sure your child eats plenty of fruit and vegetables, as well as other high-fibre foods, and keeps well hydrated. They should go to the toilet regularly to empty their bowels, but without straining to pass stools.
Occasionally, your doctor may recommend that your child has an injection of a substance called a sclerosant, which acts to help stick the mucosa lining to the muscle wall. If other treatments don’t work, your child may need surgery. 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.
You may be offered surgery. Which type of surgery is best for you depends on several different things, such as the type of prolapse you have, your age and whether you have any other medical problems. It also depends on whether or not you’re constipated.
Your may be offered abdominal surgery or perineal surgery. Abdominal surgery involves making a cut (or several cuts) in your abdomen, and is often only used for full-thickness prolapse. Older people are generally offered perineal surgery, which involves cutting around the prolapse itself. Perineal surgery is also suitable if you can’t have a general anaesthetic (when you’re put to sleep during a procedure).
Each type of surgery has its pros and cons. If you have abdominal surgery rather than perineal surgery, you’re less likely to have another prolapse afterwards. But you may be more likely to have complications after surgery, such as bleeding. You usually recover more quickly after perineal surgery, with less pain and a shorter hospital stay.
Your surgeon will advise you on the best type of operation for you.
Causes of rectal prolapse
Why some people develop a rectal prolapse isn’t yet fully understood, but it’s often associated with weak muscles in your pelvis. This can be triggered by:
- 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 related to neurological (nerve) conditions, including:
- multiple sclerosis (MS)
- lumbar 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. Your pelvic floor muscles may become weak after you have a baby.
Complications of rectal prolapse
If a rectal prolapse isn’t treated properly, it can sometimes cause complications.
Part of your rectum can become trapped, but this is rare. This can cut off the blood supply and may cause the part of your rectum that sticks out to die. This is called a strangulated prolapse. If left, the prolapse develops gangrene, which means it looks black and the dead tissue drops off. If this happens, you must seek medical advice straight away, as you will need surgery.
If you have a mucosal prolapse, you may get ulcers on the lining of your rectum where it sticks out. The prolapse may have white areas surrounded by swollen red tissue. This is called solitary rectal ulcer syndrome and happens in around 12 in every 100 people with a rectal prolapse. If your symptoms are mild, you may just need to treat any underlying constipation. But you usually need surgery to remove the lining that’s sticking out.
One in five people who have surgery for a rectal prolapse have another prolapse at some point. This can happen after any type of surgery. The prolapse is more likely to come back after perineal surgery than after abdominal surgery. If your prolapse comes back, ask your doctor about your options, as you may need more surgery.
FAQ: How common is rectal prolapse?
It’s difficult to know exactly how many people have the condition. This is because many people with rectal prolapse don’t visit their GP for advice.
Many people don’t tell their GP about their bowel symptoms, so it’s difficult to know how common rectal prolapse is. But if you or your child has a rectal prolapse, it's important to see your GP.
Rectal prolapse in adults affects mainly people over 60. It’s six times more common in women than it is in men. Most adults with rectal prolapse have had constipation for a long time.
Rectal prolapse can affect children too, especially those under four. Children with rectal prolapse are often constipated and strain when they empty their bowels.
If you don't get treatment, rectal prolapse can cause bleeding and make it harder for you to control your bowel movements. If you have a severe prolapse, it can get strangulated. This is when parts of your rectum become squashed, cutting off the blood supply. If it’s not treated, the prolapse may then develop gangrene, which means it looks black and the dead tissue drops off. The lump of rectum that sticks out then dies. If this happens, you must seek urgent medical advice as you will need surgery straight away.
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.
FAQ: How long does it take to recover after surgery?
How long it will take you to recover after the surgery will depend on the type of operation you have. It will also depend on your general health.
How long it takes to recover fully from surgery varies from person to person. It also depends on which type of surgery you have.
Your doctor can treat rectal prolapse with two different types of surgery. If you have abdominal surgery, your surgeon will make one cut or several small cuts in your abdomen (tummy). If you have perineal surgery, your surgeon will cut around the prolapse itself. Your surgeon will advise you on the most suitable operation for you.
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. It may be several days before you can empty your bowels again, and your doctor may prescribe laxatives to help. If you have abdominal surgery, you’re more likely to develop complications afterwards, such as bleeding or an infection.
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 straight away.
FAQ: What's the difference between rectal prolapse and piles?
Rectal prolapse and piles (haemorrhoids) both affect the last section of your bowel. But while rectal prolapse affects your rectal wall or lining, piles affect the blood vessels in your anal canal. Both conditions can cause similar symptoms, but they need to be treated in different ways. It's important to get the right diagnosis from your GP or specialist.
If you have a rectal prolapse, the wall of your rectum, or part of the wall, sticks out through your anus. Your rectum is the last section of your bowel. It’s where faeces (stools) collect before passing through your anus as a bowel movement.
Piles are abnormally large swellings on the inside 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. With both conditions, the lump or swelling may go back in again once you've finished your bowel movement. But you may need to push it back inside. 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 children under four. 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 to prevent any complications or your symptoms getting worse. Your GP may need to insert a finger inside you to feel your rectum and anus. If you have a rectal prolapse, your GP will notice circular rings of mucosal tissue around the lump or swelling. These rings won’t be there if you have piles.
You can treat piles with self-help measures, such as eating more fibre and drinking enough water. You can also buy over-the-counter medicines from your pharmacist to ease any pain or itching. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
You can have banding treatment or surgery to remove large piles. In adults, rectal prolapse can usually only be fully treated with surgery. In children, rectal prolapse usually gets better on its own if your child is having regular bowel movements. You can help this by giving your child plenty of high-fibre foods, such as fruit and vegetables, and enough water to drink.
If you have any questions or concerns about rectal prolapse or piles, talk to your GP.
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