What is Rectal Prolapse?

Condition

In rectal prolapse, one or more layers of the mucous membrane bulge from the circumference of the anus. Prolapse may be complete (procidentia), with all layers of the rectum protruding, or partial. A child may outgrow the condition, and drugs or surgery will help an adult.

What causes it?

Rectal prolapse usually affects men under age 40, women around age 45 (three times more often than men), and children ages 1 to 3 (especially those with cystic fibrosis). The list of related conditions includes increased abdominal pressure (especially with strained bowel movements); conditions that affect the pelvic floor or rectum (weak sphincters or weak muscles due to neurologic disorders); nutritional disorders; injury; tumors; aging; and chronic wasting diseases, such as tuberculosis, cystic fibrosis, or whooping cough.

What are its symptoms?

In rectal prolapse, tissue may bulge from the rectum during bowel movements or while walking. The person may have other symptoms, including persistent sensation of rectal fullness, bloody diarrhea, and pain in the lower abdomen caused by ulceration. Hemorrhoids or rectal polyps may coexist with a prolapse.

How is it diagnosed?

The doctor will ask about symptoms and examine the person's anus. In complete prolapse, exam reveals the full thickness of the bowel wall and, possibly, the sphincter muscle protruding, and mucosa collapsing into bulky, concentric folds. In partial prolapse, the doctor finds partially protruding mucosa and a smaller mass. He or she may ask the person with rectal prolapse to strain during the exam to show the full extent of prolapse.

How is it treated?

Treatment varies according to the underlying cause. Sometimes eliminating the cause (straining, coughing, nutritional disorders) is the only treatment necessary. In a child, prolapsed tissue usually diminishes as the child grows. In an older person, an injection (to cause a fibrotic reaction) fixes the rectum in place. Severe or chronic prolapse requires surgery to strengthen or tighten the sphincters with wire or to cur away some of the prolapsed tissue.

What can a person with rectal prolapse do?

If you have rectal prolapse, here are some helpful suggestions:

• Change your diet to prevent constipation. Ask your nurse or a dietitian about the correct diet and stool-softening routine.

• If you have severe prolapse and incontinence, wear a perineal pad while you recover.

• Ask your doctor or nurse about perineal-strengthening exercises.