Rectal Prolapse

What Is Rectal Prolapse?
Rectal prolapse occurs when all or part of the rectal wall slips out of its normal position, sometimes protruding from the anus. The rectal lining appears as a dark red, moist, fingerlike projection. Prolapse can affect bowel control, leading to leakage of stool or mucus.

Types of rectal prolapse include:

• External prolapse – The entire rectal wall protrudes through the anus.
• Mucosal prolapse – Only the inner lining of the rectum protrudes.
• Internal prolapse – The rectum drops but does not protrude outside the anus.

Rectal prolapse is much more common in women compared to men, however anyone can present with this issue.

Causes & Risk Factors
Women are more susceptible due to vaginal delivery and multiple childbirths. Other contributing factors include:

• Chronic diarrhea or constipation
• Straining during bowel movements
• Tissue damage from surgery or childbirth
• Weakening of pelvic floor muscles due to aging

Symptoms
Rectal prolapse often begins with a noticeable protrusion after a bowel movement, which may feel like sitting on a small ball. Common symptoms include:

• Leakage of stool, mucus, or blood
• Urgent need to have a bowel movement
• Frequent passage of small stools
• Feeling of incomplete evacuation
• Anal pain, itching, irritation, or bleeding

Note: Rectal prolapse should not be confused with hemorrhoids, which are swollen blood vessels that can cause itching, pain, or bleeding.

Diagnosis
Diagnosis starts with a physical exam and review of medical history. Additional tests may include:

• Defecography – Detects structural changes in the lower GI tract.
• Anal electromyography (EMG) – Checks for nerve damage.
• Anal manometry – Measures anal muscle strength.
• Anal ultrasound – Examines muscles and tissues.
• Colonoscopy or proctosigmoidoscopy – Looks inside the colon and rectum.

Treatment

Surgical repair is required to fix the rectal prolapse. An abdominal or perineal approach can be used to fix the prolapse. The perineal approach is often used in patients that are too medically frail to tolerate an abdominal surgery.

There are several procedures that can be done for this. One option is Ventral Mesh Rectopexy (VMR) which is a reconstructive technique to fix the prolapse. Surgery could also involve attaching the rectum to the lower spine for support or removing a portion of the colon that is no longer supported by surrounding tissue.

 Sometimes rectal prolapse presents along with other pelvic organ prolapse (bladder, uterus). These surgeries may be done in coordination with other specialists to fix multiple prolapsed organs at the same time in order to achieve better results.

Our surgeons often use minimally invasive techniques, such as laparoscopic or Da Vinci® robotic-assisted surgery, which allow for greater precision, faster recovery, reduced pain, and fewer complications.

Early diagnosis and treatment improve bowel function and reduce the risk of complications.