The last section of the colon is the rectum and the internal and external anal sphincter muscles, which normally prevent incontinence. The anal sphincter is the specific muscle that controls the release of stool during a bowel movement. Rectal prolapse is a medical condition, which occurs when the rectum slips from its normal position, slipping by the sphincter muscles and through the opening at the anus.
There are three types of rectal prolapse:
- Complete prolapse – The entire rectum can extend out of the anus.
- Partial prolapse – A portion of the rectal lining slips through the anus.
- Internal prolapse – The rectum starts to slip down but does not extend outside of the body
There are several possible factors that may contribute to this condition, including; chronic constipation, a lifelong habit of straining during a bowel movement, tissue damage from childbirth, having had anal surgery as an infant, malnutrition, weakening of the anal sphincter, nerve damage and infections. Also, the pelvic floor muscles weaken with age. Rectal prolapse is more common in women than men, particularly women who have had a hysterectomy.
The symptoms of a rectal prolapse include:
- Pain in the rectum and anus
- Rectal bleeding from the inner lining of the rectum
- Fecal incontinence, which can be leakage of stool, blood or mucus
- Having the feeling of a full bowel with an urgent need to have a bowel movement
- Passing several very small stools
- A feeling of being unable to completely empty the bowels
- Itching, irritation and bleeding
- A mass that is a reddish color and sticks out of the rectum, particularly following a bowel movement
Rectal prolapse is not the same as hemorrhoids, although hemorrhoids can cause rectal bleeding. Hemorrhoids are due to swollen blood vessels in the lower rectum and anus. Since the early symptoms of rectal prolapse mimic hemorrhoids, it is sometimes difficult to tell the two conditions apart.
Initially, a physician will get a thorough medical history and do an anorectal examination. The doctor often asks the patient to sit on a commode and strain as if they were having a bowel movement. If the doctor can see the prolapse, this will help confirm the diagnosis and other necessary tests. Since other conditions sometimes occur with rectal prolapse, such as urinary incontinence, bladder prolapse and vaginal/uterine prolapse, other specialists may be involved in the diagnosis and testing.
Medical tests that are commonly ordered include a sigmoidoscopy, colonoscopy, anal ultrasound and a barium enema. A MRI may be ordered to evaluate the pelvic organs. There is also a dynamic MRI that can be ordered, which actually videos the pelvic muscles and organs during a bowel movement. This test also evaluates the other pelvic organs, such as the bladder and vagina. The doctor is looking for tumors, ulcers, any abnormally narrow areas in the large intestines. If the doctor is working with a child, a sweat test will be ordered to look for cystic fibrosis.
When the rectal prolapse is diagnosed in the early stages, it may be treated with stool softeners and by pushing the protruding tissue by hand back into the anus, if ordered by the doctor. Avoid constipation by drinking plenty of water and eating a lot of fruits and vegetables; plus, food with fiber may help as well. Kegel exercises can help to strengthen the pelvic area muscles. It is important not to strain during a bowel movement.
If the prolapse does not improve with the diet change, stool softeners and the increase in water intake, then rectal prolapse surgery will be required. There are two types of surgical procedures, which depend on the extent of the rectal prolapse. One surgical procedure is called a perineal proctectomy, and the other is a sigmoid resection and rectopexy.
Rectal prolapse in children often heals on its own. If the prolapse occurs, it can be pushed back into place immediately. It may help the child to use a potty-training toilet, so they do not strain during a bowel movement. There is an injection that a physician may use to treat the prolapse. Children diagnosed with rectal prolapse should typically also be tested for cystic fibrosis, as rectal prolapse can be a sign of that disease.