Rectal prolapse​

Rectal prolapse refers to a condition where the rectum (lower part of the bowel) protrudes through the anus (back passage).

What is rectal prolapse?

There are two forms of rectal prolapse:

  • Mucosal prolapse. Only the lining of the rectal wall is involved
  • Full thickness. Where all the layers of the rectal wall are involved and protrude through the anus. Rectal prolapse is then divided into four stages – raging from mild non-protruding prolapse through to irreducible external prolapse.

Weakness of the anal sphincter muscle is often a factor and this results in leakage of stool and mucus.

What are the symptoms of a rectal prolapse?

Signs and symptoms of a rectal prolapse can include:

  • Soft tissue protruding from the anus
  • Incontinence of mucus, liquid or solid faecal material
  • Bleeding
  • Itching and irritation around the anus
  • Feeling of not being able to empty the rectum completely

What causes rectal prolapse?

In most cases no single cause can be identified. It may be due to any of the following:

  • Life long habit of straining during defaecation associated with constipation
  • Result of stresses involved in childbirth
  • General aging process causing weakness of the ligaments supporting the rectum, as well as loss of tightness of the anal muscles.
  • Some cases may be neurological, caused by injury or disease
  • Rectal prolapse can occur in infants and in women who have never had a baby. It is more common in women than men.

How is a rectal prolapse treated?

There are many different operations to correct rectal prolapse. Abdominal, rectal or laparoscopic surgery may be suggested. The surgeon will discuss with you which method would be most likely to achieve the best result, taking into account your age and physical condition, the extent of the prolapse and pelvic floor function, and the results of other relevant tests.

It is extremely important to have your rectal prolapse fixed. As the rectum prolapses through the anus, the anus becomes stretched. Eventually the anus becomes so stretched that it becomes permanently damaged, resulting in a permanent loss of bowel control.

Surgical procedures for correction of rectal prolapse include:

For mild mucosal prolapse.

The prolapsing wall of the rectum is removed and the wall is reinforced by folding it like a concertina.  Mostly used for mucosal or minor full thickness prolapse.

Most suitable for patients with obstructed defaecation, rectocele or minor prolapse problems.  The pelvic floor muscles are sutured back together between vagina and rectum, giving support to the front wall of the rectum.

The rectum is drawn up and stitched onto the lower spine.  This is rarely used since the advent of laparoscopic surgery.

For full thickness rectal prolapse.  Using Keyhole surgery, the rectum is drawn up and stitched onto the sacrum (tail bone).

The prolapsing bowel is cut off through the anus.

The prolapsing bowel is removed through the tummy and the rectum is anchored to the sacrum.  Usually performed laparoscopically.