The rectum is a five-inch section of the lower end of the large intestines, or colon, that ends with the anal opening. The tube-shaped structure is attached to the body by ligaments and muscles and functions as a temporary storage site for feces until elimination. The rectum can slip out of place and protrude through the anal opening, resulting in a condition called rectal prolapse.
Types
Three types of rectal prolapse exist, depending on the extent of slippage and protrusion. In internal prolapse, which is most common in children, the rectum slips out of place but does not pass through the anal opening. Partial or mucosal prolapse occurs when only the lining of the rectal mucosal membrane slips out of place, not the entire rectal wall. Full thickness rectal prolapse, also referred to as complete prolapse, is the most common form of rectal prolapse and occurs when the entire rectal wall protrudes through the anal opening. Protrusion may occur only during bowel movements initially, but if left untreated, protrusion occurs while standing or walking.
Symptoms
Rectal prolapse is a painless condition, but it can cause some uncomfortable and unwanted complications. The prolapsed rectum may appear as a reddish-colored mass sticking out of the anal opening and may be more prominent following bowel movements. There may be minor bleeding or leakage of stool or mucus. Complications of a prolapsed rectum include constipation, a frequent urge to have a bowel movement or problems with nutrient absorption leading to malnutrition.
Causes
Rectal prolapse is generally a condition of the elderly and occurs more often in women than men. The rectum is held in place by ligaments and muscles, and when these become weakened or overstretched, slippage occurs. This happens most often as a result of the general aging process or childbirth. Other causes of rectal prolapse include long-term constipation, tissue damage during surgery and structural abnormalities in the pelvic and abdominal region. Certain conditions or diseases increase the chance of having a prolapsed rectum, especially in children, such as cystic fibrosis or celiac disease.
Treatment
Treatment depends on the type of prolapse, but surgery is generally needed to completely repair a prolapse rectum. According to the Mayo Clinic, two surgeries are generally performed for a prolapsed rectum--a sigmoid resection followed by a rectopexy and a perineal proctectomy. The first involves laparoscopically removing a section of the colon through the abdomen and anchoring the rectum to the sacrum, the lower part of the spine. A perineal proctectomy is removal of the prolapsed rectum through an incision in the rectum. Less invasive treatments, primarily for early stages and children, include stool softeners to prevent straining during bowel movements or using a warm, moist cloth to gently apply pressure to the prolapsed rectal mass to push it back through the rectal opening.
Diagnosis
Diagnosing rectal prolapse is most often done by analyzing a description of symptoms and a physical exam. A complete medical history is also important to identify previous medical conditions or surgeries that could increase the chance of having a prolapsed rectum. A doctor will perform a digital rectal exam to feel for loose rectal tissue and to analyze the strength of the anal muscles. Other tests may also be needed to rule out other conditions that might resemble a prolapsed rectum, such as hemorrhoids.
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