Rectal prolapse occurs when part of your rectum, or the lining of your rectum, pushes through the anus, which can be uncomfortable and cause issues passing a stool. It is more common in women due to the added pressure of pregnancy and childbirth but can also occur in women who haven’t given birth, and men. You may be offered various treatment options for rectal prolapse, both surgical and non-surgical which we’ll discuss in this article.
Treatment without Surgery
In the early stages of your condition, your doctor may advise treatments for rectal prolapse that are non-surgical. These include:
Eating plenty of fruit and vegetables and other foods that contain fibre to try to prevent constipation and reduce straining. This would prevent the prolapse from worsening.
Doing pelvic floor exercises. These can strengthen the pelvic floor and supporting abdominal muscles, as well as the anal sphincter muscle. For guidance on how to perform these properly, please visit our page on Pelvic Floor Exercises for specific guidance for Men or Women.
Laxatives may be used if you have difficulty increasing your dietary fibre. Your GP or clinician may suggest you take bulking or osmotic laxatives, such as Fybogel, Movicol to help you empty your bowels without straining. Your doctor will also advise you to drink plenty of water, about 1.5-2 litres a day.
In children, rectal prolapse usually gets better without any treatment. Your GP will give you advice on how to get your child into a regular bowel routine. Ensure your child has plenty of fruit and vegetables in their diet, as well as foods that contain fibre. Also ensure your child drinks enough water. Your GP will also advise you on how to push your child’s rectum back into their anus when it prolapses.
Occasionally, your doctor may recommend your child has an injection of a substance called a sclerosant to help destroy the prolapsed tissue or surgery. However, this is only considered if other treatments have not been successful. It will also depend on how old your child is and how serious their condition is.
Rectal Prolapse Surgery
Generally there are two approaches to surgery; the perineal and abdominal approach – either by a repair through the anus without external incision (Delormes procedure) or through an incision in your abdomen (abdominal rectopexy). The rectopexy can be done laparoscopically with 4 or 5 very small incisions instead of one large incision across your lower abdomen.
The choice of surgery depends on many factors including age, other health issues, presence of incontinence, surgeon preference and the size of the prolapse. Your surgeon will advise you on the best type of operation for you.
Different types of Rectal Prolapse Surgery
- Perineal approach – The rectal prolapse can be pulled out through the anal canal and operated on from below.
- Abdominal approach – By operating from within the abdomen the rectum can be hitched up to prevent it prolapsing down. Abdominal approaches can be carried out either through conventional open wounds or by laparoscopic (keyhole) surgery. The rectum is fixed with either sutures or mesh. Occasionally, it may be planned to remove part of the colon as well.
It’s important to remember that the rectal prolapse may come back after you have surgery by either method. The likelihood of a successful operation will depend on the type of surgery you have and your individual circumstances. It is important therefore to continue to reduce straining after having surgery
Following surgery normal activities can be resumed after 2 weeks but heavy lifting should be avoided for 6 weeks. It is important to avoid constipation and stool softeners and pain killers are usually given at discharge from hospital.
Further information
The choice of surgery depends on many factors including age, other health issues, presence of incontinence, surgeon preference and the size of the prolapse. Your surgeon will advise you on the best type of operation for you. For more information on Symptoms and Diagnosis, visit our page on Rectal Prolapse.
