rectal prolapse

Rectal prolapse is not incredibly common, affecting roughly 2.5 out of every 100,000 people. Still, it’s essential to know the signs and symptoms of rectal prolapse, as a majority of those cases are women who are over the age of 50. The medical term “prolapse” comes from the Latin prolabi, meaning literally “to fall out,” and refers to when an organ falls or slips out of place and is no longer located where it should be. When a rectal prolapse occurs, the rectum begins to push its way through the anus slowly, and in more severe cases, the rectum can push its way through and be visible externally. Usually, the rectum is the last part of the large intestine and remains firmly attached, unless there is a case of prolapse. Read on to learn more about the causes and risk factors for rectal prolapse, the differences between prolapse and hemorrhoids, what to do if you suspect prolapse, and what treatments are available. 

Causes, Risk Factors, and Related Conditions of Rectal Prolapse

Doctors are not always able to pinpoint why some patients get rectal prolapse and others do not. However, there are some specific causes in some patients. Pregnancy can be a cause in some patients. Because pregnancy lowers the pelvic floor, in some patients this can cause rectal prolapse. In addition, some patients may strain while pushing during labor and delivery. 

In that same vein, if you find yourself routinely constipated and pushing and straining while trying to force a bowel movement, this may predispose you to a rectal prolapse either now or later in life, particularly if you’re female. Women over 50 are six times more likely to develop rectal prolapse than any other age group or gender group, with women over 60 being the age group most likely to have rectal prolapse. This is because of the overall weakness of the pelvic floor. Also, conditions that make you cough a lot – such as chronic bronchitis – can be a precursor to rectal prolapse. 

Doctors have also noted that 15 percent of patients with rectal prolapse also suffer from chronic and frequent diarrhea, although the connection between the two is not known. 

Certain conditions are also correlated with rectal prolapses, such as multiple sclerosis (MS), spinal tumors, lumbar disk disease, or any type of injury to the pelvis or lower back. 

Factors that may put you at risk for rectal prolapse, other than age, include: 

  • Chronic obstructive pulmonary disease (COPD)
  • Cystic fibrosis
  • Hysterectomy
  • Diabetes
  • Parasitic infections
  • Weakened anal sphincter

It is unlikely for children to suffer from rectal prolapse, but it is possible, particularly if they also suffer from a correlating disease or conditions, such as MS. 

Rectal Prolapse Vs. Hemorrhoids

Rectal prolapse may be slightly uncommon, but hemorrhoids are not. Very often, prolapse can be mistaken for what is a severe case of hemorrhoids. However, how can you tell? It can be tough to know on your own, considering your angle of viewing. If you’re unsure, it’s best to go to your doctor for an evaluation. A rectal prolapse involves the protrusion of the rectum, often out through the anus, while hemorrhoids are swollen blood vessels that appear on the walls of the anus and the lining of the rectum. Both of these conditions can be very painful, however, hemorrhoids can often be treated with over-the-counter medications. If hemorrhoids become more severe, they can be mistaken for prolapse because they can become painful and itchy, and you may also see a spot of red on the toilet paper after wiping, which is also something you’d see with prolapse. More severe hemorrhoids will require medical intervention, to begin with, so the best thing to do in this case is to make an appointment with your healthcare provider so you can receive the proper treatment, whether it is prolapse or hemorrhoids. 

Symptoms and Complications

You likely won’t notice the symptoms of rectal prolapse overnight, and symptoms will begin to manifest gradually. One of the first things you may feel is a bulge near the opening of your anus. When you sit, you may feel the sensation of “sitting on a ball,” no matter where you’re sitting or what kind of material you’re sitting on. If you feel that something is awry, take a handheld mirror with you next time you prepare to make a bowel movement. If you’re experiencing rectal prolapse, you may see a reddish-brown bulge extend from the anus. You may even see it emerge from the anal cavity, and return into the cavity after your bowel movement. This is a pretty indicative sign of a prolapse. 

If prolapse worsens and help isn’t sought, the rectum may emerge when you are performing physical activity or even normal daily activity, such as walking or going down or up a set of stairs. In the beginning, you may be able to return the rectum to its position, but over time, returning it to its position will become more challenging, and your health will be at greater risk. As the prolapse worsens, you may experience constipation or fecal incontinence, depending on the type of prolapse it is. 

Types of Prolapse

There are three distinct types of rectal prolapse that range in severity:

  • Internal: The rectum has dropped and is considered a prolapse because it has moved, but it has not pushed through the anus
  • Partial: Only a portion of the rectum has moved into the anus
  • Complete: The entire rectum extends out through the anus (most serious)

When to See a Doctor

Rectal prolapse isn’t a life-threatening emergency, especially in the beginning stages. However, it becomes a major quality of life issue in the middle and later stages and types if it is not addressed. Rectal prolapse will not get better on its own and will only increase in severity. If you think you may have rectal prolapse, then it is a good idea to see your physician as soon as possible before permanent damage is done (such as nerve damage), which can result in unwanted outcomes such as permanent fecal incontinence. 

Rectal prolapse may take years to progress from mild to severe, and your doctor may even choose to delay treatment based on your degree of severity. Still, it’s always best to get a medical opinion.

Rectal Prolapse Treatment

The only way to effectively treat a rectal prolapse is through surgery. This is in part why your doctor may choose to delay treatment if your prolapse symptoms are mild in the beginning. There are two ways to perform the surgery to put the rectum back into place. The surgeon can perform it through the abdomen (either open surgery or laparoscopically), and the rectum is pulled back into place, or the surgeon can perform it through the anus. This is a second option for those who cannot have abdominal surgery. This surgery can only be performed using open surgery. The surgeon will remove part of the rectum, replaced, and reattached to the large intestine to fix the prolapse. 

How to Prevent Rectal Prolapse 

There are a few ways to prevent rectal prolapse, particularly if you meet one of the other risk factors. You can:

  • Take stool softeners regularly, so you don’t push and strain during bowel movements. Stool softener should not be confused with laxatives. Even over the counter laxatives should be used infrequently or under a doctor’s supervision 
  • Eat plenty of high-fiber foods for regularity 
  • Drink plenty of water for hydration 
  • Exercise and lead a non-sedentary lifestyle
  • Perform Kegel exercises to keep your pelvic floor muscles strong
  • Manage stress with meditation and self-care techniques

To learn more about rectal prolapse, or if you would like to be evaluated by a physician, request an appointment as Gastroenterology Consultants of Savannah, P.C. today. We have five Georgia locations and one South Carolina location to help provide individualized care and serve you better.