Rectal prolapse

About rectal prolapse

Your rectum is the last part of your digestive system. Food passes through your small bowel (the longer, thinner part of your bowel) and nutrients are absorbed. Food waste then travels through your large bowel where it becomes solid faeces. Your rectum, at the end of your large bowel, is where faeces collect before passing through your anus as a bowel movement.

Your rectum is made up of three layers and includes:

  • the rectal wall lining (mucosa)
  • a layer of muscle (muscularis propria)
  • fatty tissue surrounding the rectum (mesorectum)

Rectal prolapse occurs when the wall of your rectum, or part of its lining, protrudes through your anus. This may happen when you're having a bowel movement, but can also happen when you cough or sneeze, or even when you're doing everyday activities such as walking or standing up.

Rectal prolapse mainly affects women over the age of 70, but it can also happen at any age and to men and young children (usually under the age of four).

Types of rectal prolapse

There are three main types of rectal prolapse.

  • Full-thickness rectal prolapse is when part of the wall of your rectum (including all three wall layers) protrudes through your anus.
  • Mucosal prolapse is when the lining of your rectum protrudes through your anus.
  • Occult or internal intussusception rectal prolapse, is when your rectum folds in on itself but doesn't protrude through your anus.

Symptoms of rectal prolapse

The most apparent symptom of rectal prolapse is a lump or swelling coming out of your anus. Initially you may only have this when you have a bowel movement, but as the condition develops it may also happen when you cough or stand up. However, if you have internal intussusception rectal prolapse, there may be no lump or swelling coming through your anus, but you may feel as though something is still in your rectum after you empty your bowels.

You may find that you’re able to push the lump back in using your fingers. But as the conditions worsens, this may become more difficult and you may find that as soon as you've pushed it back in it protrudes out again, or you can't push it back in at all.

Rectal prolapse can make it difficult for you to control your bowel movements and you may end up soiling your underwear or have a slimy discharge from your rectum. These symptoms can make it difficult for you to maintain good hygiene.

You may have some bleeding from your rectum and discomfort in the area. You may also develop an ulcer on the prolapsed part of your rectum.

Complications of rectal prolapse

Complications of rectal prolapse can include bowel incontinence (faecal incontinence).

Although rare, part of your rectum can become trapped, which will cut off the blood supply and cause the protruding mass of tissue to die – this is called strangulated prolapse. It can be extremely painful and may cause the prolapsed part of your rectum to swell. If this happens, seek urgent medical attention.

Causes of rectal prolapse

The exact reasons why rectal prolapse develops aren't fully understood at present, but it’s often associated with weakened muscles in your pelvis. It’s known to be related to certain conditions that put extra pressure on your abdomen (tummy), such as: 

  • pregnancy
  • constipation and/or straining when having a bowel movement
  • diarrhoea
  • disorders that cause persistent coughing, including cystic fibrosis, chronic obstructive pulmonary disease (COPD) or whooping cough

Rectal prolapse is also related to neurological conditions, including:

  • multiple sclerosis (MS)
  • lumbar disc disease
  • lower back or pelvic injury
  • spinal tumours

In older women, rectal prolapse can occur at the same time as a prolapsed womb or bladder. This is thought to be due to a general weakness in your pelvic floor muscles (the group of muscles that form a supporting sling between your pubic bone and the base of your spine). This may be related to pregnancy and childbirth.

Diagnosis of rectal prolapse

Your GP will ask about your symptoms and examine you – he or she may need to insert a finger inside your rectum to examine you and will wear gloves to do this. He or she may also ask you about your medical history. 

Your GP should be able to diagnose a rectal prolapse, but he or she may refer you to a doctor who specialises in conditions affecting the bowel for further tests, such as a:

  • defecography, also known as evacuation proctography, which is a type of X-ray that shows your rectum and anal canal when you're having a bowel movement
  • sigmoidoscopy, which is a procedure that uses a thin tube with a tiny light and camera at the end to allow a doctor to look at the inside of your rectum and bowel
  • endoanal ultrasound, which is a procedure that uses a thin ultrasound probe to look at the muscles used for bowel control

You may also have other tests to rule out any underlying conditions that may be causing your rectum to prolapse.

Treatment for rectal prolapse

In children, rectal prolapse usually gets better without any treatment. Your GP will give you advice on how to get your child into a regular bowel routine. Ensure your child has plenty of fruit and vegetables in their diet, as well as foods that contain fibre. Also ensure your child drinks enough water. Your GP will also advise you on how to push your child's rectum back into their anus when it prolapses.

Occasionally, injections of sclerosant or surgery may be needed. However, this is only considered if other treatments have not been successful, and will be dependant on your child’s age and how serious their condition is.

In adults, in the early stages of your condition, you may be advised to take bulking laxatives, such as Fybogel, to help you empty your bowels without straining. However, in most cases you will need to have surgery.

Surgery

The only way to effectively treat a full-thickness rectal prolapse is to have surgery.

There are different types of surgery, but each type falls into two broad categories depending on where the cut is made to operate. The operation will involve your surgeon either making a cut in your abdomen (this may be one cut or a number of smaller cuts), or around the prolapse itself, which is known as perineal surgery.

Your surgeon will advise you on the best type of operation for you.

How common is rectal prolapse?

Answer

The exact number of people with rectal prolapse is difficult to estimate as many people with the condition may not tell their GP about it.

Explanation

Rectal prolapse is a condition that’s often under-reported. This is because many people who have it don't tell their doctor about it, especially those who are elderly. Rectal prolapse in adults most commonly affects women in their 70s.

Rectal prolapse can also affect children. However, this is fairly uncommon and normally only affects children under the age of four.

If you or your child has a rectal prolapse, it's important that you see your GP. If untreated, rectal prolapse can cause bleeding, incontinence, ulcers to form on the prolapsed part of your rectum, and in severe cases, a strangulated prolapse. A strangulated prolapse is when parts of your rectum become squashed, cutting off the blood supply and causing the protruding mass of tissue to die. If this happens, you must seek urgent medical attention.

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.

How long does it take to recover after surgery to treat rectal prolapse?

Answer

The length of time it will take you to recover after surgery to treat rectal prolapse will depend on the type of operation you have and the state of your health. It's important to remember that our bodies are all different and we all heal at different rates.

Explanation

There are two different categories of procedure used to treat rectal prolapse: abdominal procedures and perineal procedures. The operation will involve your surgeon either making a cut in your abdomen (this may be one cut or a number of smaller cuts), or around the prolapse itself. Your surgeon will advise you on the most suitable type of operation for you.

Generally, people who have a perineal procedure have less pain and usually spend less time in hospital (one to three days) than those having an abdominal procedure (three to seven days). However, if keyhole surgery is used on your abdomen the time it takes to heal may be shortened.

The length of time it will take you to fully recover from your operation will very much depend on your individual circumstances. Talk to your surgeon about what to expect before you have your operation.

Newer procedures involving internal trimming and stapling may be available. Your surgeon will advise you on how suitable these treatments are for you.

If you have any further questions or concerns about surgery to treat rectal prolapse, talk to your doctor or surgeon.

What's the difference between rectal prolapse and haemorrhoids?

Answer

Rectal prolapse and haemorrhoids are conditions that affect the last section of your bowel. Rectal prolapse affects the rectal wall or lining, whereas haemorrhoids affect the blood vessels in your anal canal. However, both conditions can have similar symptoms. It's important to get the right diagnosis from your GP as the treatment for each differs.

Explanation

Rectal prolapse is when the wall of your rectum or part of the wall protrudes through your anus. The rectum is the last section of your bowel where faeces collect before passing through your anus as a bowel movement.

Haemorrhoids are round swellings on the inside of the anal canal – the short section that connects your rectum with your anus – in areas known as the anal cushions. The swellings are caused by swollen blood vessels in the anal cushions.

Both conditions may cause a lump or mass of tissue to drop out through your anus when you have a bowel movement. With haemorrhoids, the mass will normally be smaller, but it’s possible to mistake large haemorrhoids for a rectal prolapse and vice versa. In both cases, the tissue may go back in again once you've finished your bowel movement, but for some people it may be necessary to push the mass back inside. You may also find that you have some bleeding and pain when you have a bowel movement, as well as a slimy discharge from your anus that may soil your underwear.

However, the conditions do differ in the groups of people they affect. Rectal prolapse mainly affects older people, especially women and sometimes young children under the age of four. Haemorrhoids can affect people at any age.

Your GP should be able to distinguish between rectal prolapse and haemorrhoids. It's important to get a diagnosis early to prevent any complications or your symptoms getting worse.

Haemorrhoids can be treated by using self-help measures (for example, increasing the amount of fibre in your diet and drinking enough water), medicines, banding or surgery. In adults, rectal prolapse can only be treated effectively with surgery. In children, rectal prolapse usually gets better after they get into a good bowel habit. You can do this by ensuring your child has plenty of fruit and vegetables in their diet, as well as eating foods containing fibre and drinking enough water. Your GP will give you advice on how to get your child into a regular bowel routine.

If you have any questions or concerns about rectal prolapse or haemorrhoids, talk to your GP.