• Anal Itching
• Anal Pain
• Bowel Cancer
• Constipation
• Diverticular Disease
• Faecal Incontinence
• Haemorrhoids
• Rectal Prolapse

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 your 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 your bowels but later it may come out when you are standing or walking or when you cough or sneeze. 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 you should be seen as an emergency by a doctor at hospital.

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 you to avoid straining when you open your bowels.

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

You may be prescribed a bulk laxative such as Fybogel to make the stool softer. You may also be shown how to empty your bowel more effectively so you do not strain. Suppositories or enemas may be prescribed for you to help you empty more effectively without having to strain a lot. Avoid heavy lifting, get a chronic cough treated, and maintain a healthy weight. These are all things that can reduce your symptoms.

If your rectal prolapse is causing you lots of problems and interfering with your 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 you and of 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 combination of the techniques. Your 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. B&CR Chair of Trustees, Professor Norman Williams has pioneered a technique, the EXPRESS, to combat this. 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 these pages is reproduced from material put together by the Colorectal Development Unit at the Royal London Hospital, part of Barts and the London NHS Trust. An information leaflet prepared by the Colorectal Development Unit, Barts and the London NHS Trust will soon be available to download here.