Rectal prolapse

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Definition

Rectal prolapse occurs when the rectum falls and comes through the anal opening.

Alternative Names

Procidentia; Rectal intussusception

Causes

The exact cause of rectal prolapse is unclear. Possible causes may include any of the following:

  • Defect in the pelvic floor through which hernia may slip down
  • Loose muscles of the anal sphincter
  • An abnormally long colon
  • Downward movement of the abdominal cavity between the rectum and uterus 
  • Prolapse of the small intestine
  • Constipation
  • Diarrhea
  • Chronic coughing and sneezing

A prolapse can be partial or complete:

  • With a partial prolapse, the inner lining of the rectum bulges partly from the anus.
  • With a complete prolapse, the entire rectum bulges through the anus.

Rectal prolapse occurs most often in children under age 6. Health problems that may lead to prolapse include:

  • Cystic fibrosis
  • Intestinal worm infections
  • Long-term diarrhea
  • Other health problems present at birth

In adults, it is usually found with constipation, or with a muscle or nerve problem in the pelvic or genital area.

Symptoms

The main symptom is a reddish-colored mass that sticks out from the opening of the anus, especially after a bowel movement. This reddish mass is actually the inner lining of the rectum. It may bleed slightly and can be uncomfortable and painful.

Exams and Tests

The health care provider will perform a physical exam, which will include a rectal exam. To check for prolapse, provider may ask the person to bear down while sitting on a commode.

Tests that may be done include:

Treatment

Call your provider if a rectal prolapse occurs.

In some cases, the prolapse can be treated at home. Follow your provider's instructions on how to do this. The rectum must be pushed back inside manually. A soft, warm, wet cloth is used to apply gentle pressure to the mass to push it back through the anal opening. The person should lie on 1 side in a knee-chest position before applying pressure. This position allows gravity to help put the rectum back into position.

Immediate surgery is rarely needed. In children, treating the cause often solves the problem. For example, if the cause is straining because of dry stools, laxatives may help. If the prolapse continues, surgery may be needed.

In adults, the only cure for rectal prolapse is a procedure that repairs the weakened anal sphincter and pelvic muscles.

Outlook (Prognosis)

In children, treating the cause cures rectal prolapse. In adults, surgery usually cures the prolapse.

When rectal prolapse is not treated, constipation and loss of bowel control may develop.

When to Contact a Medical Professional

Call your provider right away if there is a rectal prolapse.

Prevention

In children, treating the cause usually prevents rectal prolapse from happening again.

References

Kliegman RM, Stanton BF, St Geme JW, Schor NF. Surgical conditions of the anus and rectum. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 344.

Lembo AJ. Constipation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 19.

Madoff RD. Diseases of the rectum and anus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 145.

Version Info

  • Last reviewed on 5/11/2016
  • Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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