Rectal Prolapse
Understanding Rectal Prolapse
Rectal prolapse is characterised by unsatisfactory/incomplete bowel evacuation, that may be associated with a sense of fullness or heaviness in the rectum. There may also be a protrusion from the back passage. Rectal prolapse can often be mistaken for constipation and is typically characterised by excessive straining to defecate or a sense of incomplete evacuation, despite normal stool type.
Signs and Symptoms of Rectal Prolapse
- Excessive straining to defecate
- Unsatisfactory bowel emptying
- Abdominal bloating and discomfort
- Frequent unsuccessful attempts to defecate
Causes and Risk Factors for Rectal Prolapse
The cause of rectal prolapse is often multifactorial and may include
- Genetic predisposition
- Excessive straining to defecate
- Chronic constipation or diarrhea
- Advancing age
- Pelvic floor muscle weakness
Diagnosis of Rectal Prolapse
The first step in diagnosis of rectal prolapse is a though history and physical examination. Further evaluation to confirm diagnosis includes
- Defecating MRI
- Colonoscopy
- Functional assessment of the muscles in the anorectum via digital rectal examination
Treatment Options for Rectal Prolapse
Treatment of rectal prolapse often includes input from a multidisciplinary team. Common treatment options may include;
- Pelvic floor muscle (PFM) strengthening
- Optimising defecation technique including your toileting position, use of abdominal and pelvic floor muscles, and passive support/splinting if prolapse is relevant for you
- Adjunctive therapies utilising biofeedback (ultrasound, EMG & Rectal Balloon therapy). Biofeedback has been demonstrated to be an effective, first-line intervention for dyssynergia
- Stool manipulation through changes to dietary fibre, fluid intake, and laxatives.
- Lifestyle modifications including physical activity, weight loss, sleep hygiene, and overall relaxation
- Surgical procedures to address structural deficits, where conservative approaches have failed.