Dr Naseem Mirbagheri:
A rectal prolapse is a protrusion of the rectum, the lower part of the large bowel, into and sometimes outside the anus. This happens when the normal attachments that keeps the rectum fixed are lost, allowing the rectum to slide out.
The exact cause of rectal prolapse is unknown, but it’s most commonly seen in women aged over 50. It is associated with straining on the toilet, chronic constipation, or weak pelvic floor muscles. The link to childbirth is not clear, because women who haven’t had kids and men can suffer from prolapse.
There are various degrees of prolapse. Internal prolapse is where the rectum doesn’t come out. And external prolapse, where the rectum is pushed out. Most people with prolapse experience a lump that comes out at the time of defecation. It usually goes back by itself, but sometimes you may require manual reduction.
You can have other symptoms such as mucus discharge, discomfort, bleeding, or even incontinence. When a prolapse is suspected it’s important to rule out the important causes such as a tumour. It’s rare for this to happen, but your doctor might consider organising a colonoscopy for you.
In patients in whom the diagnosis is not clear, a radiological or x-ray study known as defecatory proctogram is done. This test involves taking pictures of a simulated defecation to confirm the protrusion of the rectum. The treatment of rectal prolapse is usually surgical, because once the prolapse has occurred it’s not possible to correct a protrusion, even if you stop straining in the toilet. There are over a hundred surgical procedures described for repairing rectal prolapse. This is an indication that treating this condition is quite difficult, and recurrence is very high.
Prolapse surgery usually involves putting your rectum back in its place, sometimes involving cutting out a length of the bowel and fixing the rectum to the pelvis. This operation can be performed laparoscopically, robotically, or via your back passage.
Some of the most commonly performed surgical repairs include laparoscopic ventral mesh rectopexy and Delorme’s procedure. Laparoscopic mesh rectopexy is a keyhole procedure which involves pulling up the rectum and fixing it in place with a use of a mesh in the pelvis. Delorme’s procedure, on the other hand, is done via your back passage and it involves suturing your rectum muscle while removing its inner lining. It’s also important to address the underlying cause of prolapse, such as straining and constipation, to reduce the risk of recurrence.
It is important for you to see your doctor if you suspect that you may have prolapse, as early treatment may have better outcomes. The surgery that best suits your situation can be recommended by your specialist.