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DIGESTIVE SERVICES

Diagnosis & Treatment

Rectal Prolapse

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How is Rectal Prolapse Diagnosed?

Diagnosis

The rectal prolapse specialists at NewYork-Presbyterian will do an initial evaluation to determine whether the signs and symptoms indicate hemorrhoids or rectal prolapse. In the initial stages, distinguishing between the two conditions is often difficult.

If a patient has a complete external prolapse, it can be simple to diagnose. However, more commonly, this is not the case, and other tests need to be utilized, such as:

  • Digital rectal examination (DRE). A physical examination of the rectum to evaluate the sphincter muscle strength and other abnormalities.
  • Colonoscopy. A long flexible tube with a tiny camera is inserted into the rectum to check for polyps, colon cancer, or other conditions that may be causing signs and symptoms of possible rectal prolapse.
  • Barium enema. A lower gastrointestinal (GI) series of video X-Rays to examine the form and function of the lower tract.
  • Defecography. A series of images using an X-Ray or MRI to study the muscles during a bowel movement.
  • Urological or pelvic exams. Depending on the signs and symptoms, other exams may be recommended to determine if there is a weakness in the pelvic floor or if other organs have prolapsed such as the uterus or bladder.

How is Rectal Prolapse Treated?

Treatment

If symptoms of a rectal prolapse don’t improve by making lifestyle changes, surgery may be recommended to avoid further complications and improve quality of life.

Lifestyle changes

Once the type of prolapse has been diagnosed by one of our rectal prolapse specialists, some at-home self-care methods may be recommended to reduce symptoms and improve quality of life. These could include:

  • Pushing the rectal prolapse back into place
  • Medications to improve bowel function
  • Stool softeners or suppositories
  • Strengthen pelvic muscles by doing Kegel exercises
  • Eating a healthy diet to prevent straining during bowel movements
Surgical treatments

In most cases, the treatment for rectal prolapse requires the rectum to be put back in its normal position through a surgical procedure.

The type of rectal prolapse surgery recommended will depend on how serious the condition is, bowel function, overall health, and age.

  • Abdominal (rectopexy) surgery. Whenever possible, a rectopexy is completed using a minimally-invasive technique (laparoscopy or robotic surgery) to promote quicker healing and less recovery time. If necessary, open abdominal surgery will be used to open the abdominal cavity to access the organs and repair the external prolapse. In cases where the patient has had a history of chronic constipation, a partial bowel resection may also be recommended to remove the problem section and improve bowel function.
  • Perineal (rectal repair) surgery. In some cases, a rectal approach to surgery is recommended when the prolapse is minor and abdominal surgery may be contraindicated. There are two types of rectal surgery used to repair the inner lining of the rectum and the portion that is protruding outside of the anus:
    • Altemeier procedure. A procedure where the prolapsed rectum is removed by pulling it out through the anus. The prolapsed segment is removed and the two ends of the large intestine (the remaining colon and anus) are sewn together to form the new rectum.
    • Delorme procedure. This procedure is used to repair a partial mucosal prolapse. In this procedure, only the redundant lining of the rectum is removed. The muscle wall of the rectum is then accordioned to help reinforce the rectum.

FAQs

FAQs

In the initial stages of rectal prolapse, you may have a consistent feeling of having full bowels or pressure in your rectum. You may also feel like you have to go to the bathroom urgently but aren’t able to fully empty your bowels and afterward they aren’t completely empty. This can also be present when lifting something, coughing, or sneezing, followed by an abnormal feeling of having a bulge in your rectal area.

In adults, if a rectal prolapse is caught early, it may improve with self-care, but without treatment, the condition will most likely get worse over time and require surgery. In children, the condition is typically considered behavioral, and the treatment is nonoperative with a higher chance of recovery.

If rectal prolapse is caught early and is minor, lifestyle changes and self-care can be tried to help relieve symptoms. If the prolapse condition doesn’t improve, surgery may be recommended to avoid further complications and improve the quality of life.

In the early stages, an external prolapse may look like hemorrhoids, although a prolapse is more severe and looks like a blob of bright red tissue sticking out of the anus.

A rectal prolapse itself is not dangerous. However, the longer you have the condition the worse it will get which can cause other dangerous complications.

The treatments for rectal prolapse vary depending on the severity of the condition and include both non-surgical and surgical approaches.

Get Care

Trust NewYork-Presbyterian for Rectal Care

If you are experiencing symptoms of rectal prolapse, contact one of the rectal prolapse specialists at NewYork-Presbyterian to set up an appointment at a location near you.

Rectal prolapse may not be a major problem in the initial stages, but it will continue to get worse over time without the proper treatment.