Rectal prolapse is a condition in which the lower portion of the colon (rectum), just inside the anal canal, becomes turned inside out. This usually occurs during evacuation. Initially, patients are usually unaware of this event. However, with repeated episodes it worsens and eventually a portion of the rectum begins to be pushed through the anal canal or to become prolapsed. It is more common in women than in men.
The development of rectal prolapse is usually associated with chronic straining during evacuation. It has also been associated with straining secondary to childbirth.
Rectal prolapse may present as rectal bleeding or the sensation of hemorrhoids. However, rectal prolapse is a different type of problem than hemorrhoids.
The diagnosis of rectal prolapse is based upon a history and evaluation of the anorectal area. Patients are evaluated initially with a rectal exam. During the rectal exam patients are asked to "strain" as if they are having a bowel movement. This usually will result in demonstration of rectal prolapse.
Other mechanisms by which rectal prolapse may be demonstrated include a defogram. This study takes x-ray pictures while the patient is evacuating. Anal rectal manometry, measurement of the pressures exerted by the internal and external anal sphincters, are also helpful.
The treatment of rectal prolapse is based upon surgical techniques. Multiple techniques are available for the treatment of rectal prolapse. This approach should be carefully discussed with your surgeon. In most cases, treatment is quite successful. It should be performed by a qualified colorectal surgeon or a surgeon who has had significant experience in this area.
Treatment of constipation should also be included in the management of patients with rectal prolapse. However, it is not sufficient to simply correct these problems if significant prolapse is occuring.
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