Rectal Prolapse

Rectal prolapse is a condition in which the inside of the rectum turns inside out and comes out of the anus with bowel movements or sometimes spontaneously. It can be brought on by straining hard and frequently trying to move your bowels. It can also happen when you lose tone or function in the muscles that hold the rectum in place. Rectal prolapse may occur in men or women, but it is more common in women.

There are two grades of rectal prolapse:

  • Partial prolapse – The lining of the rectum protrudes when you strain to have a bowel movement. Sometimes it is hard to tell the difference between this and prolapsed internal hemorrhoids, which are much more common.
  • Complete prolapse (or procidentia) – The sleeve of the rectum turns inside out and protrudes from the anus. This may occur during bowel movements. It may occur walking or standing. It can be “reduced” or put back where it belongs by standing and tightening the pelvic muscles or by manually pushing it back inside. Rarely, the prolapsed rectal tissue may remain outside the body all the time.

Causes of Rectal Prolapse

The rectum is normally suspended or held in place by pelvic muscles that create an angle between the rectum and the anal canal. For rectal prolapse to occur, there must be loss of pelvic muscle tone and loosening of the other tissues that normally tether the rectum in place. A life-long habit of straining to have bowel movements can lead to this weakness, as can the stresses involved in childbirth. Some neurologic disorders (loss of nerve supply) can lead to weakening of the pelvic and anal sphincter muscles. In rare cases, there may be a hereditary predisposition. In some cases, no single cause can be identified.

Symptoms of Rectal Prolapse

Symptoms of rectal prolapse may include:

  • Tissue protruding from the rectum after bowel movements or exercise
  • Leakage of stool or incontinence of stool
  • Not being able to feel when you are about to have a bowel movement
  • A feeling of having full bowels and an urgent need to have a bowel movement
  • Passage of many very small stools
  • The feeling of not being able to empty the bowels completely

Rectal Prolapse Treatment

The first line of treatment is aimed at preventing constipation and avoiding straining to have a bowel movement. A diet rich in fiber (25–35 grams per day) along with 6–8 glasses of decaffeinated fluids every day will assist in keeping stools soft. Physical therapy can also help strengthen weakened muscles and improve pelvic muscle tone to make the pelvic floor stronger. If prolapse can be reduced easily and does not occur spontaneously, no special additional treatment is needed. However, if this is not the case and conservative measures have failed, surgical consultation is warranted.

There are two basic types of operation for rectal prolapse: one requiring an abdominal approach and one that is done through the rectum. The abdominal approach usually involves resecting or removing the redundant part of the bowel that is coming out (resection) and tacking the rectum up on the inside so it can’t come out again (rectopexy). We believe that repairs using permanent mesh should be avoided because of their potential for long-term complications. Resection and rectopexy give the best long-term results and lowest recurrence rates.

An alternative approach is to remove the prolapsing bowel through the rectum. This is appropriate for patients who are in poor health and cannot tolerate an abdominal operation. It is usually well tolerated but has a higher long-term recurrence rate.

Surgery is most successful for people who still have some control over their bowel movements. If the anal sphincter is already weak or damaged, surgery may correct the prolapse but not correct the fecal incontinence (lack of control of bowel movements) that usually accompanies prolapse. It is important to have strong muscles of the pelvic floor. It may be recommended to have a course of physical therapy before surgery.

In some situations, if incontinence is severe, it may be necessary to do a diverting colostomy, so that the bowels no longer move through the rectum.

Additional Resources

Make an Appointment

To schedule an appointment or learn more, call the Michigan Bowel Control Program at 734-763-6295 #3.