Rectal Prolapse - Types, Symptoms, Causes & Complications

What is a Rectal Prolapse?

Rectal prolapse is an anorectal condition in which the rectum, a part of your large intestines, slips outside the anus. The rectum is an important part of the digestive system that is situated at the end of your large intestines. The primary function of the rectum is to collect and hold your feces until it’s time to release it. However, due to various factors, the rectum itself can slip out of its original position and protrude from the anus.

Rectal prolapse is usually not a medical emergency. However, the longer you have the condition, the more likely it is to worsen and lead to serious consequences. Rectal prolapse is a fairly uncommon condition with studies suggesting only 2.5 out of every 1000 people struggle with this condition. A rectal prolapse is also more common in women and people over the age of 50.

Rectal Prolapse Causes and Symptoms

Causes

A rectal prolapse can occur due to various factors. Some of the most common rectal prolapse causes are given below:

• Aging
• Pregnancy and childbirth
• Long-term history of diarrhea or constipation
• Intestinal parasitic infection
• Chronic coughing or sneezing
• Long-term history of having to strain when defecating
• Spinal cord or nerve damage
• Nerve damage that affects your body’s ability to tighten or loosen muscles
• Cystic fibrosis

Symptoms

The primary symptom of rectal prolapse is the visible protrusion of the rectal tissue through the anus. During its initial stages, the rectum may return to its original position on its own. However, if the condition worsens, you may feel as if something has fallen out of your body.

Alongside, some additional rectal prolapse symptoms include:

• Feeling a bulge outside your anus
• Pain in the anus or rectum
• Feeling that there is something left inside your anus after each bowel movement
• Leakage of mucus, feces, or blood from the anus
• Seeing a red, fleshy mass hanging out from the anus
• Fecal incontinence
• Anal itching

Types Of Rectal Prolapse

Depending on the severity of your condition, rectal prolapse is categorized into 3 types: Internal Prolapse, Mucosal Prolapse, and External Prolapse.

• Internal Prolapse: When the rectum has prolapsed but not as far as protruding from the anus, it is referred to as an internal prolapse. An internal prolapse is also known as an incomplete prolapse.
• Mucosal Prolapse: A mucosal prolapse occurs when the interior lining of the rectum starts to protrude from the anus.
• External Prolapse: When the entire thickness of the rectum starts to protrude through the anus, it is known as an external prolapse. Your proctologist may even refer to this type of rectum prolapse as complete or full-thickness prolapse.

Rectal Prolapse: Tests and Diagnosis by Doctor

Diagnosing rectal prolapse is an important part of rectal prolapse treatment that will help your doctor assess the severity of your condition and evaluate your overall health. To begin, your proctologist will ask some general questions regarding your health and diet. Your healthcare provider may also review your surgical and medical history. If you are on any preexisting prescription or struggle with any condition, such as diabetes or hypertension, it is advised to let your proctologist know about them as well. To better understand your health and determine the severity of your condition, your healthcare provider will also likely perform some diagnostic tests such as:

• Digital Rectal Examination: A Digital Rectal Exam (DRE) is a commonly performed anorectal diagnostic test that is performed to check for abnormalities in the rectum, anus, and prostate gland. During this test, the doctor will insert a gloved, lubricated finger into your rectum to feel for any enlargements, tenderness, lumps, or hard spots.
• Defecography: Defecography is a radiology test that is typically performed to study the mechanics of your body during bowel movement. To perform this test, your healthcare provider will fill your rectum with a Barium paste (a medical substance that has a similar consistency to feces). Barium is a contrast agent that will make your anal canal and its surrounding muscles more visible to X-ray or MRI. You’ll be asked to evacuate this paste on a special toilet inside a scanning machine. The radiologist will then take various images of different phases as you contract and relax your muscles.
• Anorectal Manometry: Anorectal manometry is another diagnostic test that is performed to evaluate the overall functioning of your anal and rectal muscles. It is an entirely non-invasive procedure during which the doctor places a small, soft, and flexible tube inside the rectum. This tube is fitted with a small balloon. During the test, your doctor will take pressure readings at different depths inside your rectum to establish a baseline internal pressure. Once this is determined, the proctologist will inflate the balloon. The balloon will be inflated to different sizes and placed into different positions inside your rectum. The doctor will take note of all the changes in pressure readings and evaluate the functioning of your anal muscles and rectum.
• Lower GI Series: A lower GI series or barium enema is a diagnostic test that is performed to identify problems in your colon, rectum, and anus. During this test, a lubricated tube is inserted into your anus. Once in position, barium liquid (a contrast medium that will provide the radiologist with better visibility of your large intestines) is put through this tube. The doctor will then take images of the large intestines. Once enough images are taken, your doctor will remove the tube and allow you to go to the lavatory.
• Colonoscopy: Colonoscopy is a commonly performed anorectal exam that is performed to examine the insides of your large intestines (which includes your colon, rectum, and anus). During this test, the proctologist will insert a long, flexible tube, known as a colonoscope, into the rectum. This colonoscope is fitted with a tiny video camera and will allow your doctor to view the entire colon in detail.
• Electromyography: Often referred to as EMG, electromyography is typically performed to diagnose conditions or injuries that affect your muscles and nerves that control them. During this test, one or more small needles (known as electrodes) are inserted through the skin and into the muscles. The electrical activity picked up by these electrodes will help your doctor measure and evaluate their overall functionality.

Rectal Prolapse: Treatment Options and Cost

There are various surgical approaches for treating a rectal prolapse. In most cases, rectopexy surgery is considered to be the best surgical treatment for rectal prolapse. However, depending on your overall health and the specifics of your condition, your proctologist may prefer different surgical procedures. Some of the most commonly performed rectal prolapse surgeries are given below:

Abdominal Approach

• Open Abdominal Rectopexy: Rectopexy is an anorectal procedure that is performed to restore the rectum to its original position. During an open abdominal rectopexy, the surgeon makes an incision in your abdominal cavity to access your organs. Once the rectum has been located, they will attach the rectum to the back wall of the pelvis (known as the sacrum) using permanent stitches. The surgeon will also use mesh to reinforce the rectum and stop your condition from reoccurring. These stitches and mesh will hold the rectum in place long enough for scar tissue to form around it and hold it in place after that. Once the rectum has been repositioned to its original place, the incision made on the rectum will be closed using sutures, and you will be moved to a recovery area.
  An open abdominal rectopexy is typically performed under general anesthesia and may require you to stay several days in the hospital. Open surgery is invasive as well and takes long to recover. However, rectopexy has a 97% long-term success rate at treating rectal prolapse.

• Laparoscopic Abdominal Rectopexy: Laparoscopic abdominal rectopexy is an advanced and minimally invasive anorectal procedure that utilizes a laparoscope to treat rectal prolapse. During this procedure, the surgeon makes several, small “keyhole” incisions to insert a laparoscope, a long, narrow tube-like surgical instrument that is fitted with a light source and camera at the end, into the abdomen. The surgeon then uses this laparoscope to locate the rectum. Once located, they will insert small, specially designed surgical tools through the incisions. The surgeon will then relocate the rectum back to its original position and fix it in place using permanent sutures. They may also use a mesh to reinforce it further and prevent it from slipping again. Once the rectum has been relocated, the incisions will be closed with sutures or stapler and you will be moved to a recovery area.
  Similar to open surgery, a laparoscopic abdominal rectopexy is also performed under general anesthesia and can take anywhere from 90 to 150 minutes to complete. Due to its minimally invasive nature, however, it provides patients with shorter recovery time and minimal chances of any postoperative complications.

Perineal Approach

• Altmeier Procedure: An Altmeier procedure is another surgical treatment that your healthcare provider may suggest to treat rectal prolapse. Altmeier procedure is a perineal approach to treating rectal prolapse and involves pulling the rectum out through the anus and removing it. If the sigmoid colon is involved in the prolapse, your doctor may remove that as well. Once the prolapsed rectum and sigmoid colon are removed, the two ends of your large intestines (the remaining colon and anus) are closed using permanent sutures. The new end of your colon now becomes your new rectum. At this point, the surgery is considered complete and you will be moved to a recovery area. You may also be asked to spend a few days at the hospital.
  Compared to open abdominal rectopexy, altmeier procedure is less invasive and provides patients with a shorter recovery time. However, your condition may recur afterward. The entire procedure is performed under general anesthesia and can take anywhere from 50 to 180 minutes to complete.

• Delorme Surgery: If you only have a mucosal prolapse or a minor case of external prolapse, your proctologist may suggest a Delorme procedure to you. In a Delorme surgery, only the prolapsed mucosal lining of your rectum is removed. The muscle walls of the rectum are then folded back onto itself to reinforce it and stitched together inside the anal canal. Once completed, you will be moved to a recovery area where you will be kept under observation by your healthcare provider. If there are any complications, they will be addressed promptly.
  The entire procedure is typically performed under general anesthesia and does not take more than 60 to 70 minutes to complete. One major benefit of the Delorme procedure is that it can improve your overall bowel function and reduce the risk of recurrence. The recovery period of fairly short as well with most patients requiring 2-4 weeks at most.

Rectal Prolapse Treatment Cost

On average, rectal prolapse treatment cost in India can start from Rs. ₹100000 and go up to Rs. ₹200000. The exact surgery cost, however, will likely vary depending on a multitude of factors, such as:

• Consultation charges
• Operating fees
• Method of Surgery
• Expertise of your preferred surgeon
• Hospital charges
• City you are in
• Preoperative tests and diagnostics
• Postoperative follow-ups

What to Expect After Rectal Prolapse Surgery?

Generally, a rectopexy procedure can take anywhere from 60 to 150 minutes to complete. It is also performed under general anesthesia so, once the procedure is complete, you will be moved to a recovery area. Rectopexy is a major surgical procedure and your healthcare provider will likely instruct you to spend 2 to 3 days at the hospital for perineal rectopexy. If you had an abdominal rectopexy, the stay may be as long as a week. During this time, you will be kept under observation by your doctor and any problems or complications that may occur will be addressed promptly.

Once your doctor is assured that there are no more risks of any complications and you are recovering as expected, you will be allowed to go home. You should expect to feel some pain or discomfort around the surgical site and rectal area for a few weeks after surgery. If you had an abdominal procedure, your abdomen may be tender as well. However, these side effects are considered normal and generally do not require any medical intervention. Follow your healthcare provider’s instructions and take any prescribed medications for pain relief.

Recovery After Rectal Prolapse Treatment

In most cases, a complete recovery after rectal prolapse surgery can take anywhere from 4 to 6 weeks. It is to be noted, however, that the healing capabilities of every patient are different, and depending on your overall health, quality of postoperative care, and method of surgery, the overall recovery time may vary. If your recovery is taking slightly longer, do not panic and consult with your healthcare provider.

During the recovery period, it is advised to drink lots of healthy fluids and use stool softeners. Consuming a fiber-rich diet can also help you recover and minimize chances of constipation or excess straining during bowel movements. Such complications during recovery can slow it down significantly and may even lead to the recurrence of your condition. During recovery, it is also imperative that you avoid any strenuous activities or exercises that put too much pressure on the perineal region. These include weight lifting, running, contact sports, or bicycle riding. You may also experience discharge, discomfort, bruising, swelling, and mild bleeding for up to 6 weeks after your surgery. However, such side effects are considered normal and are not indicative of any complications. But if they continue to persist or worsen over time, contact your healthcare provider as soon as possible.

When performed by a qualified and experienced proctologist, chances of any complications after rectal prolapse surgery are rare and the procedure is typically considered to be safe. However, to ensure smooth recovery and minimize the chances of any postoperative complications as much as possible, your doctor may instruct you to follow some simple tips and guidelines, such as:

• Diet: Including fiber-rich foods in your daily diet, such as cereals or whole grain bread, can not only help your body get the important nutrients it needs to recover but also minimize the chances of constipation. It is also imperative that you avoid eating any junk or highly processed foods as well. These include french fries, chips, fried foods, etc. Fiber supplements such as Metamucil, Benefiber, and Psyllium may help you recover as well.

• Stay Hydrated: Hydration plays a major role in helping your body recover and encourage healthy bowel movements. Hence, it is extremely important to stay hydrated during your recovery period. Drink at least 2-3 liters of water every day. However, avoid carbonated beverages or caffeinated drinks. Instead, prioritize healthy fluids such as fresh fruit juice and coconut water.

• Avoid Strenuous Activities: Strenuous activities of any kind or exercises that exert too much force on the anal region are to be avoided. These include heavy weight lifting, bicycle riding, running, jogging, or participating in contact sports. Such exercises could exert too much force on the surgical site and affect your recovery.

• Avoid Alcohol and Tobacco: Alcohol and tobacco can leave you extremely dehydrated and hinder recovery. Hence, it is best to avoid them for some time.

• Refrain from Sexual Intercourse: After any kind of surgery involving the abdomen or pelvis, healthcare providers advise to refrain from sexual intercourse for at least 6 weeks after surgery. Once the period is over, it is still advised to consult with your healthcare provider first.

• Have Sufficient Rest: Rectopexy procedure is a major surgery that involves relocation of the rectum itself to its original position. It can be very taxing for the body to undergo such a procedure and hence, it is important to take it easy for the duration of your recovery. Take some time off from work and have sufficient sleep. Most healthcare providers advise having at least 7 to 8 hours of sleep in order to give your body enough time to heal itself.
• Attend Follow-up Consultations: After your rectal prolapse surgery, your proctologist will likely schedule some postoperative consultations with you. The aim of these appointments is to ensure a smooth recovery and address any complications that may have occurred. Such appointments are also a good opportunity for you to ask any questions you may have regarding the recovery period and inform your doctor about any odd symptoms during recovery.

Non-Surgical Treatment for Rectal Prolapse

When it comes to rectal prolapse, certain non-surgical alternatives and home remedies can help you manage its symptoms. However, especially for adults, a rectal prolapse cannot improve without surgery.

Some non-surgical options and home remedies for managing rectal prolapse symptoms are given below:

• Kegel Exercises: Kegel exercises are performed to strengthen the pelvic floor muscles and provide support to the bladder and bowel function. Kegel exercises are simple clench-and-release exercises that involve lifting, holding, and then relaxing the pelvic floor muscles.
• Fiber-Rich Diet: A chronic case of constipation is one of the most common rectal prolapse causes. However, eating a fiber-rich diet that includes foods such as whole wheat bread, lentils, black beans, kidney beans, soybeans, apples, and almonds helps increase the weight and size of the stool. Such foods can also soften the stool to allow it to pass more easily and help prevent constipation.
• Bowel Movement Management: Maintaining good bowel health is one of the most crucial parts of managing rectal prolapse symptoms. Aim to go to the toilet at least 3 times a day. It is also advised to avoid holding any bowel movement for long periods of time. If you feel the urge to defecate, do it as soon as you can.
• Ice Packs: Applying an ice pack over the affected area can help you gain significant relief from the swelling and discomfort caused by rectal prolapse.
• Stay Hydrated: Water plays a major role in digestion and is one of the best ways to ease chronic constipation. While a fiber-rich diet can increase the weight of your stool and soften it up, it also draws water into the bowel, which can leave you dehydrated. Hence, it is important to drink plenty of water. Typically, healthcare providers advise drinking at least 2-3 liters of water every day.

Rectal Prolapse: Risks and Complications

As previously mentioned, complications of any kind after rectal prolapse surgery are rare, and the procedure is generally considered to be safe. However, as is the case with any other surgical procedure, there can still be complications, and they should not be taken lightly. Some complications that are associated with rectal prolapse surgery are given below:

• Bleeding: Minor bleeding or small amounts of blood on your stool is a common side effect of rectal prolapse surgery and should subside on its own in a few weeks after surgery. However, major bleeding that does not stop on its own could be a sign of complication. In such a case, apply firm and direct pressure on the surgical site. Once the bleeding is under control, contact your healthcare provider as soon as possible.
• Infection: Infection of the surgical site is one of the most common complications that can occur after rectal prolapse surgery. An infection can occur due to various reasons, such as improper protocol in the operating room or poor quality of postoperative care. If you notice symptoms of infection, such as redness, delayed healing, fever, pain, or tenderness around the surgical site, it is advised to contact your healthcare provider as soon as possible. If caught early, most cases of postoperative infections can be treated with antibiotics and topical creams.
• Injury to Nearby Organs: While actual cases are rare, a punctured, perforated, or damaged organ can pose a serious medical risk to a patient. Surgical errors during a rectal prolapse surgery can cause injury to the organs around the rectum. Depending on the severity of the damage, your surgeon may need to perform additional procedures to correct it.
• Anastomotic Leak: If the two ends of your bowel that were removed and reconnected to simulate a rectum fail to heal correctly, it can lead to leakage of the bowel. Such complications usually require further surgical intervention for treatment.
• Constipation: In some rare cases, patients report their constipation getting worse after the procedure or sometimes occurring when they did not have it before. One possible reason behind this complication could be the formation of scar tissue in the bowels.
• Sexual Dysfunction (ED): A rectal prolapse surgery has a small chance (around 1% to 2%) of damaging the nerves connecting with male sexual function. Such damage could lead to erectile dysfunction.

What Happens if Rectal Prolapse is Left Untreated?

In its initial stage, you may be able to live with a rectal prolapse by taking care of it at home and pushing your rectum back manually. However, a rectal prolapse will continue to get worse over time and if left untreated, could lead to some serious complications, such as:

• Fecal Incontinence: Fecal incontinence or accidental bowel leakage is the accidental passing of solid or liquid stools from your anus. As the anal muscles continue to stretch, you may have difficulty holding gas or feces. Among people struggling with rectal prolapse, 50% to 75% report also struggling with fecal incontinence.
• Constipation: Constipation is a condition in which a person has infrequent or uncomfortable bowel movements. Due to bunching of the rectum and problems with muscle coordination, you may have difficulty passing stool. As a result, your condition could worsen even further. Some patients also report having alternating constipation with incontinence.
• Rectal Ulcers: Rectal ulcers are sores that can develop within the rectum and lead to various conditions, such as inflammatory bowel disease, solitary rectal ulcer syndrome, and constipation. Due to the friction and exposure of the mucus lining of your rectum, you could experience the formation of painful rectal ulcers. These sores can often bleed and lead to conditions such as anemia.
• Incarceration: An incarcerated rectum is a major complication that can occur if rectal prolapse is left untreated for a long time. When the rectum hangs out of your anus and becomes stuck, it can be “incarcerated” and can no longer be pushed back manually. As a result, the blood supply to the rectum could be completely cut off and lead to strangulation. This could lead to tissue death and decay of the rectum (also known as gangrene).

How to Prevent Rectal Prolapse?

Preventing rectal prolapse is not always possible. However, you can take certain measures and precautions to reduce its chances as much as possible. Certain steps you can take to lower your risk of rectal prolapse include:

• Opting for a fiber-rich diet that includes foods such as fruits, vegetables, bran, and beans.
• Cutting on highly junk or highly processed foods.
• Drinking plenty of water and healthy fluids
• Exercising regularly.
• Avoid excess straining during bowel movement
• Strengthening your pelvic floor muscles
• Treat chronic bowel disorders such as chronic constipation or diarrhea
• Keeping your weight at a healthy level

Rectal Prolapse: Foods to Eat and Avoid

As previously mentioned, diet plays a major role in managing symptoms of rectal prolapse. If you are struggling with a case of prolapsed rectum, given below is a list of foods that you should eat and avoid to help manage some of its symptoms.

Foods to Eat:

• Berries and Antioxidant Fruits: Berries such as blueberries, raspberries, and blackberries are well-known antioxidants and excellent sources of Vitamin C. Such nutrients can help your body produce skin faster and boost the healing process on a cellular level.
• Fiber-rich Foods: Fiber is an extremely important component to treat rectal prolapse. To minimize chances of constipation, which could aggravate your symptoms and encourage healthy bowel movement, include fiber-rich foods such as wheat, rye, barley, oats, broccoli, orange, and melons.
• Protein-rich Foods: These typically include seafood, chicken, eggs, dairy products, lentils, and beans. Protein plays a major role in helping your body repair, make new blood cells, and boost your immune system.
• Vitamins and Mineral-rich Vegetables: Green, leafy vegetables such as kale, collard greens, spinach, and cabbage are excellent sources of dietary fiber, fat, ascorbic acid, and Vitamin K. Such foods have a great effect in bolstering the immune system and maintaining a healthy weight. These factors can prove to be beneficial for managing rectal prolapse symptoms.

Foods to Avoid:

• Processed Foods: Processed food is any food that has been altered in any way during its preparation. Examples of it include chips, fries, instant noodles, frozen meals, etc. Such foods are very low in nutrition and fiber. They also have excessive amounts of preservatives, sodium, fat, and sugar. Excessive consumption of such foods can often lead to constipation and hence, it is best to avoid them if you are struggling with rectal prolapse.
• Junk Foods: Similar to processed foods, junk foods contain high amounts of unhealthy fats, salt, and sugar. Consumption of such foods can lead to unhealthy bowel function, constipation, and diarrhea. It is best to avoid them as much as you can. Examples include deep-fried foods, grilled foods, chips, burgers, pizzas, etc.
• Sugary Foods and Drinks: Drinking sugary drinks can cause a significant increase in your blood sugar levels and lead to problems with your immune system. An increase in your blood level sugar can also make you prone to infections. It is imperative that you avoid drinking any carbonated or sugary beverages such as soft drinks, ice creams, candies, etc.
• Alcoholic Beverages: Excessive consumption of alcohol can tear away at tissue in the digestive tract and the intestines, leading to rectal bleeding and blood in stool. If you are struggling with rectal prolapse, alcohol can cause major complications and cause your condition to worsen. It is best to avoid them as much as you can.