What Is Rectal Prolapse?
Rectal prolapse occurs when the rectum turns inside out and protrudes through the anal opening. It ranges from a small amount of tissue visible after straining to a large segment of rectum permanently outside the anus.
Types:
- Mucosal prolapse: Only the lining protrudes.
- Complete prolapse: Full thickness of rectum protrudes.
- Internal prolapse (intussusception): Rectum telescopes inside itself without external protrusion.
Symptoms
- Tissue visibly protruding through the anus, initially with straining and later at rest
- Feeling of incomplete evacuation
- Mucus discharge
- Bleeding from the exposed rectal surface
- Incontinence of stool or gas
- Constipation
- Discomfort during walking or sitting
Causes and Risk Factors
- Chronic straining (constipation, difficulty passing stool)
- Weakness of pelvic floor muscles (childbirth, ageing)
- Chronic cough
- Prior anorectal surgery
- Neurological conditions
- Malnutrition (particularly in children)
Diagnosis
Clinical examination is often sufficient. Additional evaluation may include defaecography, anal manometry, and colonoscopy depending on the patient's age and presentation.
Treatment Options
Conservative Management (Children and Mild Adult Cases)
- Correction of constipation and straining
- Nutrition improvement
- Toilet training in children
- Pelvic floor exercises in adults
Surgical Treatment (Most Adult Cases with Complete Prolapse)
Various techniques, chosen based on patient factors:
- Abdominal rectopexy (preferred for younger, fitter patients)
- Perineal procedures (Delorme, Altemeier) for older or higher-risk patients
- Modifications based on individual case
Choice of surgical approach is a specialist decision based on the patient's age, general health, prolapse features, and functional status.
Recovery
Varies by procedure. Abdominal procedures: 2 to 4 weeks recovery. Perineal procedures: 1 to 3 weeks.
Related Conditions
Piles (Grade IV)