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What Are the Symptoms of a Rectal Prolapse?

A woman of African-American descent, who is young, is standing in a bathroom and experiencing chronic constipation, rectal prolapse symptoms

Rectal prolapse symptoms can be extremely unpleasant and cause all kinds of issues. Recognizing the rectal prolapse symptoms means that you can get treatment quickly.

What is Rectal Prolapse?

Rectal prolapse means that the rectum (the last part of the large intestine) is sliding out through the anal opening. It is caused by a weakening of the normal attachments that keep the rectum fixed in place and inside the body.

Rectal Prolapse Symptoms

Rectal prolapse symptoms may or may not result in an obvious bulge. The typical symptoms are:

  • Constipation, diarrhea, or both at different times. Constipation is caused by the prolapse blocking the passage of stool.
  • A reddish-colored mass visible sticking out of the anus
  • Feeling that you are not empty after a bowel movement
  • Rectal bleeding or mucus emerging from the rectum
  • Fecal incontinence, meaning small amounts of feces leak from the anus

The prolapse often goes back inside on its own but is likely to recur. You should talk to your doctor if you have any of these symptoms, and seek emergency treatment if you are bleeding heavily or the prolapse cannot be pushed back inside the body.

Rectal prolapses are typically painless but can be uncomfortable.

What Causes Rectal Prolapse?

The causes of rectal prolapse symptoms are poorly understood, but one known cause is weakness in the pelvic floor muscles. This is often associated with people who have given birth multiple times. Other causes are weakness in the anal sphincter or the absence of some of the structures that normally hold the rectum in place.

In young children, rectal prolapse is typically caused by constipation or diarrhea. Most children recover from rectal prolapse once the underlying cause is treated.

Who Is More Likely to Get Rectal Prolapse?

The vast majority of adults with rectal prolapse are women and others are assigned female at birth. It used to be believed that it was caused by multiple vaginal births, but it does also occur in people who have not given birth. Other risk factors include:

  • Chronic constipation, which can result in straining that damages the structures around the rectum
  • Chronic diarrhea
  • Cystic fibrosis
  • Any disease that affects the pelvic floor muscle
  • Certain intestinal parasites
  • Having had pelvic surgery
  • Whooping cough

Rectal prolapse is very rare in children and when it does occur is typically in children under four.

How is Rectal Prolapse Diagnosed?

Rectal prolapse is typically diagnosed by a physical exam. Your doctor will look for obvious signs of prolapse. If the prolapse is not visible, they may ask you to strain to see if that makes it visible and/or do a digital rectal exam.

Various tests might also be ordered, including a colonoscopy, a defecography (which uses scans to create a video of how your rectum holds and empties stool), or a lower GI series. These tests are typically to look for other problems or confirm the diagnosis, however. The primary diagnosis is a physical examination.

Doctors may also do an anorectal manometry, which evaluates the muscles in your pelvis, rectum, and anus.

How To Treat Rectal Prolapse

Rectal prolapse tends to become worse if not treated. Untreated rectal prolapse can cause permanent fecal incontinence, as stretching of the anal sphincter muscle increases, and with the risk of nerve damage. You might start to experience episodes simply from standing up.

In adults, rectal prolapse is treated surgically. Unfortunately, surgery is still considered to be the best treatment.

The most common method is surgery through the abdomen. This may be done using open surgery or laparoscopy (or robotic-assisted surgery). The surgery is called rectopexy. The surgeon will detach the rectum from the sides of the pelvis, pull it upwards, and then secure it to the sacrum. This holds the rectum in place and then the body can be allowed to heal and form scar tissue that secures the rectum in place. The surgery has an over 90% success rate. If you have a long history of constipation, the surgeon may also remove part of the colon to improve bowel function. Unfortunately, some patients do experience new or worsening constipation after the surgery.

Your surgeon will typically recommend that you increase your intake of fiber and fluids after the operation and may prescribe a stool softener. People who have had a rectal prolapse should take steps to reduce constipation. There is some risk of sexual dysfunction.

Perineal surgery is recommended for those who are older and may not tolerate abdominal surgery or for emergency treatment of an “incarcerated” prolapse (meaning it cannot be put back inside). This involves the removal of the rectum and securing the remaining colon. It has a higher risk of recurrence (30%) but a shorter recovery period. The pelvic floor muscles are also typically tightened with sutures to reduce fecal incontinence.

Small prolapses are sometimes treated with the Deforme procedure, which strips away the inner lining of the rectum and then stitches the muscles on itself.

The prognosis is typically good, with surgery relieving or greatly improving symptoms for most patients. The anal sphincter muscles often regain strength once the prolapse has been corrected.

Children typically recover from rectal prolapse without surgery, although it may be necessary in some cases, particularly in children over four years old. The highest incident is in the first year of life and it appears to be associated with development. However, in children, the underlying cause of the prolapse needs to be identified and treated. In young children, rectal prolapse is often associated with constipation, infectious diarrhea, and even protected coughing from a respiratory infection. Because of this, it’s more common in less developed countries where infectious diarrhea is more of an issue.

Rectal prolapse is most often diagnosed from symptoms and physical examination of the anus. If you have a bulge from your anus or the symptoms above, you should talk to your doctor, especially if you have recently had a bout of constipation or diarrhea. Treatment is typically surgical, and post-surgical management involves increasing fluids and fiber to reduce constipation and possibly taking a stool softener.

If you are experiencing rectal bleeding or other symptoms, you should talk to Allied Digestive Health. We can help establish the cause and restore you to good digestive health.