Rectal prolapse is an uncommon but debilitating condition that occurs when the rectum falls out of the anus during bowel movements, strenuous activity or sometimes, even at rest. The rectum can spontaneously return to its normal position but the prolapse frequently has to be reduced or pushed back in with manual pressure. This can be very alarming and scary for the patient, especially the first time that it occurs.
Who Does Rectal Prolapse Affect?
Rectal prolapse most commonly affects older females with a long-standing history of constipation or straining with bowel movements. Other common traits of rectal prolapse patients include a history of previous pelvic surgery and patients with multiple previous pregnancies and vaginal deliveries. However, rectal prolapse can affect younger patients as well, especially if they have a history of strenuous exercise or occupations that require a significant amount of straining of the pelvic floor muscles. Rectal prolapse can affect men too, though it is much less common. Patients with connective tissue disorders can also be affected by rectal prolapse.
Diagnosis of Rectal Prolapse
A definitive diagnosis is usually made with a thorough history and a brief office examination. However, additional studies may be obtained both to determine the cause of the prolapse and the best method for surgical repair. These studies can include colonoscopy, specialized MRI or X-ray tests, or anal physiology testing. Consultation with a colorectal surgeon is important both to address the prolapse and ensure your symptoms are not from a different condition, such as hemorrhoids.
Treating & Managing Rectal Prolapse
Rectal prolapse requires surgical correction that is either performed from within the abdomen or from the perineum, depending on the severity of the prolapse and the overall health of the patient.
The abdominal approach to rectal prolapse repair involves straightening the rectum and suturing the tissue around the rectum to the strong connective tissue around the sacral bone. This may involve the removal of a segment of colon if constipation is also present. This surgery can often be accomplished through minimally invasive techniques, either laparoscopically or robotically. This is the more long-lasting repair, but it does require general anesthesia to accomplish.
The perineal approach involves removing the excess or prolapsing colon and rectum from an incision around your anus. This approach does carry a higher risk of recurrence, but it can be performed under sedation or with a nerve block for a patient that cannot tolerate general anesthesia.
What is Pelvic Organ Prolapse?
Pelvic organ prolapse means that multiple pelvic organs including your rectum, vagina, or bladder are prolapsing simultaneously. While this can be very debilitating and disconcerting for the patient, it can be surgically corrected in a minimally invasive fashion through a team approach between your colorectal surgeon and a specialized pelvic floor surgeon called a Urogynecologist.
If you are suffering from rectal prolapse or pelvic organ prolapse, we would be happy to provide surgical consultation at Memorial Advanced Surgery so we can start working on your individualized surgical plan of care today.