Rectal prolapse

Learn more about rectal prolapse and obstructed defecation. You are not alone with this problem. 

Rectal prolapse

Far to many people are suffering with defecatory dysfunction. People may describe ‘constipation’, or a difficulty in passing a bowel motion. In obstructed defecation, it may be hard to initiate defecation, and emptying often feels incomplete. There may be a sense of a blockage, or a bulge alongside the anus or into the vagina (rectocoele). Stools may be small and fragmented. There may be a need to return to the toilet up to many times over the course of a morning, and a failure to adequately empty the rectum can lead to faecal incontinence. There are lots of options to improve this – please see your GP for a referral to a colorectal surgeon. 

 

Rectal prolapse is common. A rectal prolapse occurs when there is loss or weakening of the supporting structures of the rectum. This allows the rectum to descend and infold, much like a telescope may fold inside itself. This infolding (medically called intussusception) may result in those difficulties with defecation, called obstructed defecation.

The typical symptoms of obstructed defecation are:

The prolapse may be internal, or progress to become external, or full-thickness. An external prolapse may be subtle and confused with haemorrhoids, or become very large. A prolapse can be irritated, uncomfortable or painful, and result in bleeding, mucous discharge or incontinence. For our elderly folk, a rectal prolapse can make nursing care difficult, and can greatly effect quality of life. A prolapse in a young person can be equally devastating for quality of life and body confidence. A prolapse is typically more common in women after childbirth, and more common with increasing age along with the natural weakening of supporting structures that occurs with age. There may be an increased likelihood in connective tissue weakness disorder, such as Ehlers-Danlos syndrome, or other collagen deficiencies. 

Diagnosis of a rectal prolapse is often obvious for a colorectal surgeon, with examination, or a photograph if you are comfortable taking a “belfie” (butt selfie). 

Investigation of a rectal prolapse often requires a colonoscopy to exclude other causes of defecatory disturbance, anorectal functional studies or an x-ray defecating proctogram (DPG).
Treatment may include dietary modification, stool softeners or the use of enemas. It may be beneficial to see a pelvic floor physiotherapy specialist. Surgery may be required, particularly if conservative measures do not improve symptoms.

There are a multitude of surgical options, and these need to be tailored to the patients individual circumstances, other medical problems, health priorities and overall health. Certain types of prolapse may be better repaired with particular procedures. Generally speaking, a prolapse can be repaired via the abdomen (think about us pulling the rectum up straight and fixing it in position), or can be repaired from below via the anus (think about tightening up or cutting out any excess tissue). There are benefits and particular considerations with each approach, and you should understand the appropriate options for you, so that a shared decision can be made on how to repair your rectal prolapse. 

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