What is rectal prolapse?
Full-thickness rectal prolapse means the wall of the rectum turns out through the anus, often during bowel movements and later with standing or coughing. Mucosal prolapse and prolapsing piles can look similar but need different treatment.
Symptoms may include mucus, bleeding, incomplete emptying, constipation and leakage. Weak pelvic support, long-term straining, childbirth injury, ageing and neurological disease can contribute.
What are the symptoms of rectal prolapse?
Common symptoms are:
- Tissue coming out of the anus during bowel movements, and later on standing or coughing
- Needing to push the tissue back after a bowel movement
- Mucus, bleeding or soiling of underwear
- A feeling of incomplete emptying, constipation or leakage
- A prolapse that cannot be pushed back or turns dark or very painful, which needs urgent care
How is rectal prolapse diagnosed?
The diagnosis may be clear on examination or from a photograph taken when the prolapse is present. The surgeon checks its length, whether it reduces, sphincter function and any associated vaginal or uterine prolapse. Colon evaluation may be advised before surgery.
Selected patients need defaecography, bowel transit tests, anal pressure testing or ultrasound of the sphincter. A detailed bowel and continence history helps choose the operation.
When does rectal prolapse need surgery?
Supportive measures can reduce straining and protect the skin, but they do not correct a full-thickness prolapse. Surgery is considered when the prolapse causes bleeding, leakage, difficult emptying, discomfort, trapping or a major effect on daily life.
An abdominal repair is often chosen for a fit patient. A perineal operation through the anus may reduce the physiological stress for a frail or older patient. No single route is best for everyone.
How is rectal prolapse repaired, and what are the risks?
Laparoscopic or robotic rectopexy fixes the rectum inside the pelvis. Ventral mesh rectopexy limits dissection behind the rectum and may suit selected patients, but mesh risks require specific consent. Resection rectopexy removes part of a long sigmoid colon in selected patients with marked constipation. Perineal procedures remove or fold the prolapsing rectum through the anus.
Risks include bleeding, infection, bowel injury, a leak after bowel resection, constipation, urgency, urinary or sexual problems, mesh complications and recurrence.
Recovery after rectal prolapse surgery
Hospital stay depends on the operation and general health. Walking, clot prevention and a bowel plan begin early. The aim is a soft, formed stool without repeated straining or diarrhoea.
Seek advice for fever, worsening abdominal or pelvic pain, vomiting, inability to pass stool or gas, heavy bleeding, urinary difficulty or a trapped recurrent prolapse. Bowel control and constipation may improve, stay the same or occasionally worsen and should be reviewed separately from healing.
When to seek urgent care
Seek urgent help if the prolapse cannot be gently reduced, becomes very painful, dark or heavily bleeding, or occurs with abdominal pain, vomiting or inability to pass stool. Do not repeatedly force a swollen prolapse back.