Rectal prolapse occurs when part of the rectum protrudes from the anus so it can be seen or felt as a lump outside of the anus. It can occur in children but more commonly in the elderly. It is much more common in women than men. Exact cause is unknown and the condition is not well understood. It is likely that multiple factors are involved and it is often associated with other pelvic floor conditions.
Symptoms
Patient usually experience prolapse during defection when they may see or feel a lump protrude from the anus. It often reduces (goes back) by itself but sometimes it may need to be pushed back manually. It is often associated with other bowel symptoms such as constipation, straining, difficulty empty the rectum, feeling of incomplete emptying or incontinence. Other symptoms may include mucous discharge and bright red bleeding.
As the cause of rectal prolapse may be multi-factorial, variety of investigations may be required. These include:
- colonoscopy
- defaecating proctogram
- anorectal physiology (manometry, pudendal nerve conduction study, transanal US)
- examination under anaesthesia
Treatment
Treatment options vary depending on patient factors and disease factors. It usually involves a combination of non-surgical as well as surgical management.
Non surgical treatment are aimed at improving bowel function and prevent constipation and straining. These may include bulking agents, improving toilet habits, biofeedback (retraining toiling habits) and dietary advice.
Surgical options varies depending on the degree of prolapse and general health of the patient. The aim of surgery is to reduce the redundancy of the rectum while preserving sphincter function. This can be achieve either via the abdomen (from the top) or via the anus (from the bottom). Surgery from abdominal approach are usually performed laparoscopically (key-hole).
Your surgeon will discuss the various options and recommend the most appropriate treatment option.