Prolapse literally means "To fall out of place." In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is used for organs protruding through the vagina, rectum, or for the misalignment of the valves of the heart. A spinal disc herniation is also sometimes called disc prolapse.
Rectal prolapse is a condition in which part of the wall or the entire wall of the rectum falls out of place. In some cases, the rectum may stick out of the body (protrusion).
There are three types of rectal prolapse.
- Partial prolapse - The lining of the rectum falls out of place when you strain to have a bowel movement. Sometimes this is confused with an internal hemorrhoid (which may itself prolapse).
- Complete prolapse - The entire wall of the rectum falls and usually sticks out of the body. This may occur during bowel movements. It may occur walking or standing. Rarely, the tissue may remain outside the body all the time.
- Partial and complete prolapses may be able to be pushed back inside the body. The prolapse is then said to be reduced (pushed back inside).
- Internal prolapse (intussusception) - Part of the wall of the colon (large intestine) may slide into or over another part, much like the moving parts of the telescope. The tissue does not hang out of the body. It occurs inside (internal).
There are multiple causes of rectal prolapse. A life long habit of straining to have bowel movements, stresses involved in childbirth, weakening of the anal sphincter muscle, and/or weakening of the ligaments that support the rectum are frequent causes. Neurological problems, such as spinal cord transaction or a spinal cord disease, can also lead to prolapse. In rare cases there may be a genetic predisposition. In most cases, though, no single cause can be identified.
Symptoms of a rectal prolapse may be:
- Leakage of stool
- Bleeding, anal pain, itching, irritation
- Tissue that protrudes from the rectum
Other accompanying symptoms may be:
- A feeling of having full bowels and an urgent need to have a bowel movement
- Passage of many very small stools
- The feeling of not being able to empty the bowels completely
Treatment should be aimed at avoiding constipation and avoiding straining to have a bowel movement. A diet rich in fiber and drinking 6 to 8 glasses of decaffeinated fluids every day will assist in keeping stools soft. In some cases physical therapy with biofeedback can assist with avoiding straining. If anal sphincter muscles are weak, Kegels are recommended. Physical therapy can also help strengthen weakened ligaments and anal sphincter muscles.
Two types of surgery are used to treat a complete prolapse. A surgeon may operate through the belly to secure part of the large intestine or rectum to the inside the abdominal cavity (rectopexy). Sometimes the surgeon removes the affected part of the intestine.
Surgery also can be done through the area between the genitals and the anus (perineum) to remove the prolapsing tissue
Surgery is most often successful for people who still have some control over their bowel movements. If the anal sphincter is damaged, surgery may correct the prolapse but not be able to completely correct fecal incontinence (lack of control of bowel movements). In some cases, fecal incontinence improves after prolapse surgery and in some cases fecal incontinence worsens.