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by Howson A

Rectal Prolapse

(Mucosal Prolapse; Partial Prolapse; Complete Prolapse; Internal Prolapse)

Definition

The rectum is the end section of the large intestine. A rectal prolapse is when the rectum stretches and falls through the anus. Early treatment can improve outcomes.
Rectal Prolapse
Rectal prolapse
Copyright © Nucleus Medical Media, Inc.

Causes

This problem is caused by weak muscles and ligaments. These structures hold the rectum in place.

Risk Factors

This problem is more common in children who are 1 to 3 years of age. It is also more common in older adults.
Things that may raise the risk in children are:
  • Cystic fibrosis
  • Prior anal surgery
  • Malnutrition
  • Straining during bowel movements
  • Infections
Things that may raise the risk in adults are:
  • Straining during bowel movements
  • Pregnancy and the stress of childbirth
  • Hemorrhoids

Symptoms

Symptoms may be:
  • Problems controlling stool (poop)
  • Pain when passing stool
  • Loss of urge to pass stool
  • Feeling of incomplete emptying
  • Constipation
  • Bleeding or mucous from the anus
  • Anal pain or itching
  • Tissue that sticks out of the anus

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. It will focus on the anus and rectum.
Images may be taken. This can be done with:
  • Defecography—a series of x-rays of the rectum and anus taken during a bowel movement
  • Colonoscopy —a visual exam of the rectum and colon using a flexible tube with a tiny camera
An anorectal manometry may also be done. This can measure the strength of the anal muscles, feeling in the rectum, and the reflexes needed to pass stool.

Treatment

Prolapse in children tends to go away on its own. In adults, gentle pressure to the rectum can sometimes push it back into place.
The goal of treatment is to put the tissue back into place. Options are:

Medications

Certain medicines may help to ease pain and straining when passing stool. Stool softeners and bulk agents.

Surgery

Some people may need surgery. Options are:
  • Laparoscopic rectopexy—A laparoscope (a tiny camera) is placed through a small incision in the abdomen. The rectum is secured in place with stitches.
  • Perineal proctectomy—An incision will be made in the rectum. Tissue that is sticking out of the anus is removed.

Prevention

To lower the risk of this problem:
  • Drink plenty of fluids.
  • Eat a healthful diet that is high in fiber .
  • Do exercises to strengthen the pelvic floor.
  • Do not strain when passing stool.

RESOURCES

American Gastroenterological Association
http://www.gastro.org
American Society of Colon and Rectal Surgeons
https://www.fascrs.org

CANADIAN RESOURCES

Bad Gut—Canadian Society of Intestinal Research
https://www.badgut.org
Health Canada
https://www.canada.ca

References

Constipation in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/constipation-in-adults. Accessed August 20, 2021.
Constipation in children. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/constipation-in-children. Accessed August 20, 2021.
Rectal prolapse. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/rectal-prolapse. Accessed August 20, 2021.
Rectal prolapse and procidentia. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/rectal-prolapse-and-procidentia. Accessed August 20, 2021.

Revision Information

  • Reviewer: EBSCO Medical Review Board James Cornell, MD
  • Review Date: 07/2021
  • Update Date: 08/20/2021