WHAT IS IT?
The term ‘rectal prolapse’ covers a number of conditions in which the rectum (the lowest part of the bowel) loses its proper attachment within the pelvis and telescopes downwards. It occurs in both men and women. Most men who suffer from this problem have it diagnosed when they are fairly young (often in their thirties or forties), whilst most women will be a little older, with the biggest presenting age group being women in their sixties.
Prolapse may be internal, where the bowel drops down inside the rectum, causing a partial blockage, or external, where the rectum comes out of the anus.
External prolapse can be very distressing. It may involve part of the wall of your rectum (full-thickness rectal prolapse) or just the lining of the rectum (mucosal prolapse) coming out during a bowel movement or when you cough. You may be able to push it back with your finger, but sometimes the prolapse may stay outside or come out when you stand up.
In patients with internal prolapse, the rectum folds downwards but does not protrude from the anus. This is also known as intussusception.
Other types of pelvic floor weaknesses that can accompany prolapse include rectocoele, enterocoele and sigmoidocoele.
WHAT ARE THE CAUSES?
There is no single cause. We know from studies that people with chronic constipation who have been straining for a long time may be at risk. Multiple births by vaginal delivery, especially in case of prolonged labour or forceps extraction, may also increase risk. Hysterectomy (removal of the womb) can bring an underlying weakness in the pelvic floor to light. Some (often young) people are predisposed to prolapse as they have weak connective tissues. They often have signs of hypermobility (above average mobility of joints and skin). Smoking also weakens connective tissue.
WHAT ARE THE SYMPTOMS?
Patients with internal prolapse may feel like they have a blockage in the bowel when trying to pass stool (Obstructed Defaecation Syndrome), or that something is left behind after a bowel movement. Many patients report symptoms of constipation and some experience pain or a sensation of dragging or ‘pelvic heaviness’.
Patients with external prolapse will see or feel a lump coming out of the anus.
It is common for patients with prolapse to suffer from faecal incontinence. This is because the continuous protrusion of the bowel through the anal sphincter muscles stretches and damages these muscles. The prolapse can also damage the pelvic (pudendal) nerves by stretching, leading to decreased bowel control. Finally, the prolapsing bowel can mimic stool in the rectum and trigger a reflex of your bowels to open spontaneously.
HOW IS IT DIAGNOSED AND TREATED?
To assess the severity of your prolapse the surgeons at Oxford GI have developed the ‘Oxford Classification’ for rectal prolapse. This system is now being used all over the world to grade prolapse.
External prolapse can be easy to diagnose, as the rectum can be felt or seen protruding from the anus when you push as if during a bowel movement. We do understand that often it is hard to simulate this situation during your examination in clinic. It can sometimes be helpful to take a picture of your bowel in its worst situation and bring this to clinic to show your consultant.
If you have symptoms of internal prolapse (intussusception), your surgeon will examine you and will probably recommend some tests to assess the extent and location of the prolapse. These may include anorectal physiology, defaecating proctogram, colonoscopy or examination under anaesthetic
It is often useful to undergo a course of pelvic floor retraining. This can alleviate symptoms and help to strengthen supportive muscles. Even when surgery will be needed, pelvic floor retraining prior to surgery can speed up your recovery, improve your overall bowel function and give better long term results after surgery.
Surgery may be necessary, and this will depend on the nature of your problem. Types of surgery that may be considered included laparoscopic rectopexy, STAMP, STARR, Anterior Delormes or rectocoele repair. Your surgeon will discuss the most appropriate course of action and the risks and benefits of surgery with you.
WILL IT GET WORSE IF IT IS NOT TREATED?
It is impossible to say for certain, but in general prolapses do tend to get worse over time. Prolapse can be present in a younger person but may not become apparent until later in life, particularly after menopause in women, where hormonal changes affect the supportive tissues within the pelvis.
Usually it will be up to you to decide whether you can live with your symptoms. However, if left untreated, prolapsed bowel lining (mucosa) may become thickened, ulcerated and may bleed. It is also worth noting that in external prolapse with bowel incontinence, delaying treatment for a long time may lead to an increased risk of nerve damage and inability to correct the incontinence.
Prolapsed bowel does not have a higher chance of becoming cancerous than any other part of the bowel.
Please be advised that the information on this website is not a substitute for professional medical advice, diagnosis or treatment