Rectal Prolapse

Rectal prolapse is a condition in which part, or all, of the wall of the rectum slides out of place. Early in this condition, the rectum does not protrude from the body, but as the condition progresses, protrusion is seen. Rectal prolapse may result in leakage of stool or mucus. The condition occurs in both sexes, although it is more common in women than men.

Rectal prolapse has several contributing factors, including straining upon defecation, or the stresses of childbirth. Increased age, a weakening of the ligaments supporting the rectum and loss of sphincter tightness are also risk factors.

Symptoms of rectal prolapse, which can be the same as hemorrhoids, include bleeding and rectal protrusion, although the underlying anatomical issue is different. In rectal prolapse, a portion of the bowel higher within the body is involved (can be 1-6 inches or more), while hemorrhoids develop only near the anus (1/2 to 1 inch).

A patient history, as well as diagnostic testing, can assist in making a rectal prolapse diagnosis. A patient may be asked to strain as if having a bowel movement so that the prolapse may be witnessed. If a prolapse is internal, an exam may be performed called a defecography, which is a series of x-rays taken while the patient simulates a bowel movement to evaluate the rectum and anal sphincter. Anorectal manometry, a test that measures whether or not the muscles around the rectum are functioning normally, may also be used.

Surgery is usually necessary to repair rectal prolapse; which kind depends upon the condition of the patient and the extent of the prolapse. Surgery is typically very successful in cases of rectal prolapse.

Your surgeon may choose to perform a sigmoid resection and rectopexy, which involves removing the sigmoid colon through an incision in the abdomen. Then the rectum is anchored to the sacrum, a bony structure attached to the lower spine and pelvis. In most cases this is done laparoscopically.

In some cases, the surgeon may perform a perineal proctectomy, which is done through an incision in the rectum. While this is less invasive and recovery is quicker, this procedure produces much lower long-term success rates. This may be an option for persons of advanced age or ill health.

As with hemorrhoids, it is very important for patients to avoid constipation and straining. To have soft, regular bowel movements:

• Drink at least 8 tall glasses of water a day.
• Maintain a high fiber diet. Fiber passes into the colon and can results in a larger, bulkier stool, which is soft and easier to pass. If you gradually work up to three fiber servings a day, you will find you can tolerate the fiber much better. Some high fiber sources include:
  • Whole grain (whole wheat) breads
  • Bran cereals
  • Vegetables—root (potatoes, carrots, turnips), leafy green (lettuce, celery, spinach), or cooked high residue (cabbage)
  • Fruit—cooked or stewed (prunes, applesauce) or fresh fruit (skin and pulp)
  • Bulking agents such as:
    • Food bran—available as wheat, oat or rice bran.
    • Psyllium bran—available as Metamucil, Konsyl, Effersyllium, Per Diem Fiber, or their generic equivalents. Although labeled a laxative, these aren’t really laxatives and are safe for everyday use.
    • Methylcellulose—available as Citrucel.
• Avoid narcotics (Vicodin, Percocet, oxycodone, codeine) as these medications increase constipation.

Sometimes a laxative is needed to stimulate more frequent bowel movements, but they are not a good long-term solution as it can damage the nerves of the colon. Osmotics (milk of magnesia, magnesium citrate, MiraLax, GoLytely) are safer than stimulants (Senokot, castor oil, Dulcolax, Ex Lax). Do not take any laxative product for more than seven days in a row.

A bowel retraining program can be implemented for severe constipation. This includes a diet high in roughage (bran, leafy vegetables), six ounces of prune or apricot juice each morning, two large servings of stewed fruit each day, one heaping tablespoon of psyllium fiber twice a day. After a normal breakfast, set aside 15 minutes to sit on the toilet without straining to have a bowel movement. If no bowel movement occurs by the third day, you may use an enema and repeat this process.

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