Rectal prolapse

Description

A rectal prolapse occurs when the rectal wall (part of the large intestine just above the back passage) slides through the anus. It usually happens because the tissues holding the rectum in place (muscles and ligaments) have weakened so it is no longer supported adequately and when the pressure in the abdomen increases – for example when opening the bowels or coughing – the muscles around the back passage aren’t strong enough to hold it in.

If the prolapse is large, stays out most of the time or is difficult to put back, there is always a risk that it will strangulate. This is a serious problem as the blood supply can be cut off and then the rectum can perforate or the protruding tissue may die.

Symptoms

The most obvious symptom is of a lump that can be felt outside the back passage. At first it may only appear after opening the bowels (going to the toilet) but later it may come out when standing or walking or when coughing or sneezing. The lump can usually be pushed back inside but sometimes if it stays outside it can swell and become very painful (strangulated prolapse). If this happens then an emergency visit to the hospital is necessary.

Other symptoms include a slimy clear or brown discharge (mucus) through the back passage, involuntary loss of stool or bleeding. It may be difficult to maintain hygiene because of these problems.

Diagnosis

The diagnosis of a rectal prolapse is usually based on the symptoms that you have and a routine examination of your rectum. To get a more accurate assessment of the size and significance of a rectal prolapse, a special x-ray (called an evacuation proctogram) may be performed.

Treatment

Medical treatment for a rectal prolapse aims to improve symptoms and prevent the prolapse from getting worse. This management involves treating any constipation and helping people to avoid straining when opening the bowels.

Increasing the amount of fibre in the diet can make it easier to open the bowels. Eating a high fibre diet (including five portions of fruit / vegetables daily) and drinking six to eight glasses of water each day helps to avoid constipation.

A bulk laxative such as Fybogel may be prescribed to make the stool softer. Sometimes people will be shown how to empty their bowels more effectively to avoid straining. Suppositories or enemas may be prescribed to help empty more effectively without having to strain a lot. People with rectal prolapse should also avoid heavy lifting, get a chronic cough treated, and maintain a healthy weight. These are all things that can reduce the symptoms.

If the rectal prolapse is causing lots of problems and interfering with daily life, then surgery is often advised. The doctor at the hospital clinic will discuss the risks and benefits of surgery based on his examination of the individual and the prolapse. Surgery may be performed through the rectum, through the perineum (the skin between the vagina and the anus), through the abdomen or a by using a combination of the techniques. The surgeon will discuss these in more detail. The operation will put back the prolapse but in some patients this cannot not improve leakage from the back passage so this may continue.

Outcomes and further sources of support

Unfortunately in 30% to 40% of patients rectal prolapse recurs after surgery. To further reduce this risk, it is important to follow the above advice – eating healthily, drinking plenty of water, avoiding straining on the toilet and keeping a healthy weight. A specialist colorectal nurse will also be able to provide support.

The information on this page is reproduced from material put together by the Colorectal Development Unit at the Royal London Hospital, part of Barts Health NHS Trust.