Rectal prolapse is a condition that many people live with for years before mentioning it. It is treatable, and understanding what it is takes most of the worry out of it. Here is a clear overview of the symptoms, why it happens, how it is diagnosed, and the options for treating it.
What is rectal prolapse?
Rectal prolapse happens when the rectum loses its normal support and slips downward, sometimes protruding through the anus.
At first, the prolapse may happen only during a bowel movement and return inside afterward. Over time, it may occur even without a bowel movement or become more difficult to push back into place. It is more commonly seen in women, but men can also have rectal prolapse.
Symptoms
When rectal prolapse does cause symptoms, they often include:
- A sensation of pressure, fullness, or a bulge around the anus
- Tissue protruding from the anus, especially during a bowel movement
- Difficulty having a complete bowel movement
- Constipation and straining
- Mucus drainage
- In some cases, problems controlling gas or bowel movements, or rectal bleeding
Why rectal prolapse happens
The common thread is weakening of the tissues and muscles that support the rectum over time. Risk factors include:
- Chronic constipation and years of straining
- Aging and the natural loss of tissue strength
- Pelvic floor weakness
- Prior pelvic surgery
- Multiple pregnancies
- Chronic diarrhea in some people
- Conditions that affect the nerves or muscles involved in bowel function
How it is diagnosed
A colorectal specialist can usually diagnose rectal prolapse with a physical exam and a discussion of your symptoms.
The exam is brief and private. In some cases, imaging such as a defecography is used to see how the rectum empties and how the pelvic floor moves during a bowel movement. This helps your physician judge the extent of the prolapse and which treatment makes sense.
Treatment options
Treatment is tailored to the type of rectal prolapse. In general, “internal” rectal prolapse can be managed conservatively without surgery, whereas “external” rectal prolapse is best treated with surgery.
Conservative treatment
- A high-fiber diet and adequate water to keep stool soft and avoid straining
- Treating chronic constipation at the source
- Stool softeners when needed
- Avoiding prolonged straining during bowel movements
- Pelvic floor therapy in some cases to address associated bowel function problems
These measures can help improve bowel habits and reduce straining, but they generally do not correct an established rectal prolapse in adults.
Surgical treatment
When rectal prolapse is significant, it can be repaired surgically. The procedure restores the rectum to its normal position and helps prevent it from prolapsing again.
Surgery may be performed through the abdomen or through the area around the anus, depending on the individual patient. A colorectal surgeon will walk you through whether surgery is appropriate, the approach, and what recovery looks like.
What happens if rectal prolapse goes untreated?
Rectal prolapse generally does not correct itself in adults and may gradually become more bothersome.
The prolapse may occur more frequently, become larger, or become harder to push back inside. Some people may also develop worsening problems with bowel control, mucus drainage, or bleeding. It is worth having symptoms evaluated, especially when they begin interfering with daily life.
When to see a specialist
If you notice tissue protruding from the anus, struggle to empty completely, experience rectal bleeding or mucus drainage, or develop problems controlling bowel movements, it is worth an evaluation. These symptoms are treatable, and you do not have to live with them.
Frequently asked questions
Can rectal prolapse heal on its own?
Rectal prolapse generally does not heal on its own in adults. Conservative care can help reduce constipation and straining, but surgery is usually needed to correct an established prolapse.
Do I always need surgery for rectal prolapse?
Adults with significant rectal prolapse are most often treated surgically. Your colorectal surgeon will consider your symptoms, overall health, bowel function, and the type of prolapse when deciding which treatment makes sense.
Can rectal prolapse cause bleeding?
It can. The exposed rectal tissue can become irritated and bleed. Any persistent rectal bleeding should be evaluated to confirm the cause.
Is rectal prolapse the same as hemorrhoids?
No. Rectal prolapse involves the rectum slipping downward and sometimes protruding through the anus. Hemorrhoids involve swollen tissues and blood vessels around the anus or lower rectum. The two conditions can sometimes look similar.
What doctor treats rectal prolapse?
A colorectal surgeon evaluates and treats rectal prolapse and can determine whether surgery is appropriate and which approach makes the most sense.
To talk through your symptoms and options, request an appointment with Colon Rectal Specialists or call (586) 739-5220.
