What is rectal prolapse?

Rectal prolapse occurs when some of the rectum (the final few inches of the large intestine) falls out of the body through the anus, when the muscles around the rectum become weak.
In our latest article, esteemed surgeon Mr Shahab Siddiqi explains the difference between a partial and full rectal prolapse, the symptoms, the causes and how a prolapse can be treated.

What is partial and full rectal prolapse?

When a small amount of the bowel prolapses through the anus, this is a partial rectal prolapse. It is uncommon and is easily confused with prolapsing piles. It’s less common than full-thickness rectal prolapse, where the whole tube of the bowel comes out of the anus. As such, partial prolapse is more difficult to diagnose.

What are the symptoms of rectal prolapse?

The main symptom is the prolapse coming out of the back passage. It is generally not painful, but in some instances it can be. The prolapse usually comes out when someone goes to the toilet and then goes back in afterwards. For some people, the prolapse comes out at different times which can result in the involuntary passing of faecal matter.
In long-standing prolapses, bleeding and mucus discharge may occur. Mucus is produced constantly by the large intestine but since it is produced inside a closed anus, it is reabsorbed. If the prolapse is outside the anus, the mucus can appear on someone’s underwear and cause excoriation on the skin.
A prolapse does not lead to cancer. However, the presence of a prolapse coming out of the back passage weakens the pelvic floor and over time this can cause issues.

How is rectal prolapse caused?

There is no simple answer to what causes rectal prolapse. Many people attribute it to having difficult deliveries during childbirth, which is undoubtably a contributing factor, but it doesn’t
account for the large number of men of all ages who experience rectal prolapse. Another cause is a condition known as hypermobility spectrum disorder, which causes lax connective tissue resulting in some people having soft tissues that are more stretchy than normal. People who have lifelong constipation straining are also at risk of developing rectal prolapse. A combination of all three things contribute to the likeliness of prolapse, but sometimes people who experience it have none of these factors.

How is rectal prolapse fixed?

Surgery is the only way to fix a rectal prolapse. The repair of rectal prolapse can be achieved by surgery either through the anus or the abdomen.
There are two types of surgery that take place through the anus. For smaller prolapses, the inner lining of the rectum is cut out and the muscles of the lower intestine is concertinaed together with sutures. For larger prolapses, a portion of the bowel is to be removed and then joined together.
Similarly, there are two options for abdominal surgery. The first involves operating behind the rectum and stitching it up to reduce the prolapse. The second procedure requires operating in front of the rectum, behind the vagina in women and inserting a piece of biologic or synthetic mesh, stitching it to the rectum (and vagina) and finally stitching the mesh up. This is what is called a reconstructive operation, and it’s the only procedure that attempts to reconstruct the original anatomy of the pelvis.
All of the aforementioned operations have their own advantages, disadvantages and rates of reoccurrence. If surgery was carried out through the back passage, the prolapse can come back in 1 in 3 cases. Abdominal suture rectopexy comes back in 20% of cases and in abdominal ventral mesh rectopexy (in front of the rectum using mesh), it reoccurs in 2 in 100 cases.

What are the non-surgical treatment options for rectal prolapses?

Unfortunately, there aren't any medical treatments for rectal prolapse. It isn't absolutely necessary to operate on, as a prolapse isn't considered a medical emergency. If the prolapse is
left untreated however, it will remain and probably progress, leading to damage of the pelvic floor which can result in faecal incontinence.

Can rectal prolapse go away on its own, why or why not?

A rectal prolapse will not go away by itself. In some cases, it would be sensible not to operate, for example on people who have a minor prolapse, which appears infrequently. Nonetheless, in the vast majority of situations, the prolapse is significant, on-going and needs to be operated on.

If you are experiencing rectal prolapse, you can schedule a consultation with Mr Siddiqi on his Top Doctor profile.