What is rectal prolapse?
Rectal prolapse is when the rectal wall (part of the large bowel just above the back passage) protrudes out through the anus (back passage). It can happen because the tissues holding the rectum in place (pelvic floor muscles) have weakened. In women, rectal prolapse can occur alongside prolapse of other pelvic organs such as the womb (uterine prolapse) or bladder (cystocele). Also people who have long-term constipation and straining can be at higher risk of developing rectal prolapse.
Symptoms
The most obvious symptom is of a lump that comes down and can be felt outside the back passage. Initially, it may only appear after opening the bowels but later it may come out when walking or standing and sometimes when coughing or sneezing.
The lump can usually be pushed back inside but sometimes if it stays outside for a prolonged period it can swell and become painful. If this happens then an emergency visit to your GP or the hospital is necessary.
Other symptoms include a clear or brown discharge (mucus) from the back passage, bleeding or leakage of stools. These problems can make it difficult to maintain hygiene.
Investigations
Usually, the diagnosis is obvious as the prolapse is seen when your consultant examines you in the clinic. You may require examination of your bowel by a flexible sigmoidoscopy or colonoscopy to exclude other bowel conditions prior to treatment. Sometimes, further investigations of how effectively you evacuate your bowels (proctography) and how well the anal sphincter muscles work (anal manometry and ultrasound) may be helpful. Your consultant can discuss this with you at your consultation.
Treatment
The treatment plan for your rectal prolapse will depend on several factors and will be tailored to your individual case. Often, if you are fit enough, the best way to treat the prolapse is by surgery. The type of surgery you may be offered will depend on your medical health, the type of prolapse you have and your overall bowel function (whether troubled by constipation or incontinence).
You may be offered surgery either from an abdominal or perineal (around the back passage) approach. Each approach has pros and cons. If you have abdominal surgery, you have a lower risk of the prolapse coming back but slightly higher risk of complications around the time of your surgery. Often abdominal operations can be performed by “keyhole” (laparoscopic) surgery. Unfit patients may be offered perineal surgery as it can also be performed under spinal anaesthetic for patients who are not suitable for a general anaesthetic.
Before and following any surgery your Consultant will want to treat any constipation and ensure you are empty your bowels without straining. This may include increasing the amount of water and fibre in your diet, using laxatives and also gaining the advice input of our specialist bowel management nurses.
Your consultant will discuss these treatment options with you at your consultation and advise on the best treatment plan for you.