If tissues in the rectum become weak or damaged and fall into the opening of the anus, it's a condition known as rectal prolapse.
With a rectal prolapse, the affected tissues may either move out of place or become stuck to the anal opening. The misplaced tissues are sometimes noticeable during or after bowel movements. It’s a problem that’s often treated with surgery to:
- Restore correct placement
- Address other internal issues that may be related to the prolapse
Different Types of Rectal Prolapse
More common in children and rarely seen in adults, an internal prolapse occurs when the rectum begins to drop, but it hasn’t yet pushed through to the anal area. If only part of the rectum makes its way through the anus, it’s a partial prolapse. This type of prolapse is also likely to affect children. When the entire rectal wall slips out of place and into the anal area, it’s a complete prolapse. In some cases, part of the large intestine also moves out of place.
Causes and Risk Factors
Mild rectal prolapse is often caused by strained bowel movements. It’s not clear what causes some types of rectal prolapse in children. The condition is sometimes caused by damage to nerves that control anal and rectal muscles. This may happen during surgery in this area for another issue, or as a result of pregnancy or childbirth.
In some instances, spinal injuries can damage nerves affecting tissues in this area. Having had anal surgery as an infant, having cystic fibrosis, malnutrition, and developmental problems are factors that may contribute to rectal prolapse in children. Adults with a weakened anal sphincter or chronic constipation are more susceptible to prolapse.
Signs of Rectal Prolapse
Stool leakage and blood associated with bowel movements are among the most common signs of rectal prolapse. Some patients assume they have hemorrhoids since symptoms can be similar. A slipped rectum might cause anal itching and bleeding, or a recurring feeling of having to make a bowel movement. If full prolapse has occurred, bright red tissue may be visual from the anus.
A thorough examination of the rectum and anal area that includes an evaluation of the strength of anal and rectal muscles is usually how rectal prolapse is diagnosed. Medical history and overall health are also considered. Additional tests such as a colonoscopy might be done to rule out other possible conditions. With children, a urologist may perform a sweat test to determine if the patient has cystic fibrosis if there isn’t a clear reason for a prolapse.
It’s sometimes possible to push the prolapse back into place when children have the condition. Otherwise, surgery is often necessary. Depending on the specific structures involved, surgery may be performed within the diamond-shaped area between the legs, or from the abdomen. Surgical procedures could involve attaching the rectum to pelvic floor muscles or removing part of the rectum and reinserting, reattaching, and correctly positioning it.
Oftentimes, patients will notice signs of a rectal prolapse themselves, either visually or because of symptoms like bleeding associated with bowel movements. A urologist can determine the extent of the tissue damage and recommend an appropriate surgical procedure to reposition the rectum. The risk of having a rectal prolapse may be minimized by eating high fiber foods to help avoid constipation and by maintaining good intestinal health.