Rectal Prolapse – Diagnosis and Treatment
Diagnosis
Diagnosing rectal prolapse often starts with a physical check to look for symptoms such as a bulge at the anal opening, pain, difficulty with bowel movements, or fecal leakage.
Medical professionals must distinguish rectal prolapse from other issues like hemorrhoids or complete prolapse due to malignant diseases, especially in elderly patients and young children.
A healthcare provider may perform a digital rectal exam. The provider gently places a gloved, lubricated finger into the rectum to feel the anal sphincter muscle.
During the exam, the provider may ask the patient to push down as if having a bowel movement. This process checks the muscleโs strength and reveals rectal prolapse or mucosal prolapse.
Types of Rectal Prolapse
Rectal prolapse can appear in different forms. Identifying the type helps guide treatment and predict outcomes.
Partial (Mucosal) Prolapse: Only the lining of the rectum slips out.
Complete Prolapse: The full thickness of the rectum protrudes through the anus.
Internal Prolapse (Intussusception): The rectum folds inward but doesnโt exit the body.
Other helpful tests include:
| Test Name | Purpose |
|---|---|
| Anal Manometry | Measures tightness and function of the anal sphincter. |
| Colonoscopy | Looks inside the colon to find or rule out other issues. |
| Defecography | Uses dyes and scans to see structure & changes inside. |
Anal manometry evaluates how well the muscles and nerves work and can reveal problems like pelvic floor dysfunction or neurological issues.
Colonoscopy can exclude cystic fibrosis, colon cancer, or other diseases that might cause symptoms like rectal bleeding or incontinence.
In some cases, a provider uses a defecogram or barium enema to get detailed images when a person strains.
Sigmoidoscopy can also help, especially if ongoing constipation, diarrhea, or protrusion is present. These tests together support a clear and correct diagnosis.
Treatment
Rectal prolapse has both nonsurgical and surgical management options.
Nonsurgical Management
Some people benefit from additional conservative steps to relieve symptoms and prevent worsening. Many people use stool softeners, suppositories, or other medicines for constipation.
- Increasing fiber and fluids to ease bowel movements.
- Pelvic floor physical therapy to improve muscle control.
- Avoiding straining during defecation.
- Using bulk-forming laxatives.
These strategies can help reduce symptoms, improve bowel habits, and in some cases, delay or avoid the need for surgery.
Surgical Treatment
When surgery is needed, surgeons may perform rectopexy, rectal surgery, or keyhole surgery. Colon and rectal surgeons choose the best method based on the patient’s health, age, and bowel function.
Rectopexy involves lifting the rectum and securing it to the pelvic wall to prevent it from slipping out again. This can be done through open surgery or minimally invasive methods like laparoscopy.
In some cases, part of the rectum may also be removed if there is damage or poor muscle control.
For older adults or people with other health problems, a perineal approach may be used. This involves operating through the area around the anus rather than the abdomen. These methods may offer quicker recovery with fewer complications.
Surgeons also consider how well the anal sphincter is working. In cases with severe muscle weakness, additional procedures or therapy may be needed to improve bowel control after surgery.
Most people recover well, especially when surgery is combined with steps to prevent straining and support regular bowel movements.
