The rectum — the bottom-most part of the large intestine — is kept in place by muscles and ligaments. Age, long-term constipation, and the stress of childbirth are a few of the factors that can weaken these attachments, sometimes resulting in rectal prolapse or the rectum slipping out through the anus. Rectal prolapse usually happens gradually and can protrude during bowel movements and reenter the body. If the issue is left untreated, the rectum will protrude more frequently and may remain outside the body. Doctors may choose to treat symptoms, but most cases of rectal prolapse require treatment.

Pain during bowel movements

Typically when you have a bowel movement, it should not be difficult or painful. Having pain is abnormal and indicates some underlying problem. There are many different causes of pain while having a bowel movement such as food poisoning, injury or infections. It can also be a sign of rectal prolapse. As the pain may be due to a severe medical condition, this should be ruled out by a medical professional. If you are suffering from a partial rectal prolapse, it may respond to conservative treatment. Using a stool softener may reduce pain while having a bowel movement. Use of a bulking agent such as psyllium or methylcellulose can also help reduce straining and discomfort.

Mucus or blood discharge

The presence of mucus in the stool is common, but if there is more than normal, it could be a sign of an underlying health issue. If blood accompanies it, it could indicate conditions such as irritable bowel syndrome, anal fissures or even rectal cancer. There is no one-size-fits-all solution for mucus and blood in the stools. Treatment will be different depending on the cause. A colonoscopy may help to rule out other conditions before considering treatment for rectal prolapse. This involves inserting a long, tubular instrument and examining the colon and the rectum.

Awareness of a protrusion on wiping

Early on in the development of this condition, the person may become aware of a protrusion during bowel movements. This may retract on its own afterward. Eventually, it may continue to protrude and have to be pushed back in manually. Always consult a doctor about this condition, rather than just trying to treat it at home. Once a diagnosis of rectal prolapse has been made, the doctor may give guidance on how to push the protrusion back. This may involve wearing latex gloves, using lubricating jelly on the finger and gently pushing it back into place.

Bleeding of rectal tissue

It is not uncommon for the lining of the rectal tissue to bleed. Hemorrhoids can also cause bleeding, as well as many other conditions. It may often be confusing as to whether hemorrhoids or rectal prolapse is causing the bleeding, even for physicians who do not usually treat this condition. One test a physician may use is to ask a patient to strain while squatting on the toilet and observe what happens. This is embarrassing for the patient, but it can help towards making an accurate diagnosis. Treatment for rectal prolapsed is very different to treatment for hemorrhoids.

Constipation

Constipation associated with this condition may result from the rectum bunching up. This can create a blockage and straining makes in worse. This may affect the pelvic floor and cause problems with a stool moving forward at the normal rate. It is essential to treat the causes of constipation, especially if it is chronic. If a rectal prolapse is causing it, surgery may be necessary to solve the problem. Otherwise, two simple lifestyle changes can help to bulk up the stool and keep it soft. Incorporate more dietary fiber and more water.

A loss of the urge to defecate

Patients may find that they lose the urge to move their bowels for an extended period. This usually happens only with larger prolapses. It can result in constipation as they may not be moving their bowels on a regular basis. In the absence of an urge to go, establishing a daily routine for moving the bowels is essential. Inserting a glycerin suppository may help to facilitate a bowel movement. For patients who do not have surgery, permanent problems may occur with fecal defection and the urge to move the bowels. This is because stretching out of the anal sphincter happens repeatedly. The chance of nerve damage increases too.

Fecal Incontinence (inability to control bowel movements)

In 50-75% of cases, fecal incontinence occurs. When the rectum is prolapsed, it goes past the anal sphincter. This is a structure with muscles that help the person to keep control when having the urge to move the bowels. As the rectum protrudes beyond the anal sphincter, there is an inability to control gas, liquid, or a substantial bowel movement. Undergoing surgery can fix this problem. This may be an abdominal operation or a perineal operation. Both types aim to stop the prolapse from occurring again and improve quality of life significantly. Choice of the nature of surgery will depend on factors such as a patient’s age and the extent of the prolapse.

Urinary Incontinence

20 to 35% of patients who have rectal prolapse may also experience urinary incontinence. The physician may have to do tests to find out what the prolapse is causing other problems. If a diagnosis of rectal prolapse remains unclear, a defecography may be the way to reveal the problem. This test involves a patient who is given an enema. The enema contains x-ray contrast, and ex-rays are taken during the process of having a bowel movement. The patient is given contrast to drink, and in some cases, it is placed in the vagina. This can reveal problems like urinary incontinence and bulge into the vagina.

Protrusion into the Vagina

Some women may feel as though something is bulging into the vagina and have problems with bowel movements. This can happen when the support tissue between the rectum and the vagina stretches or detaches from the pelvic bones. This causes the rectum to bulge into the vagina. Vaginal problems can be sorted out at the same time as the surgery for the rectal prolapse. A multi-disciplinary approach to the operation is usually necessary if urinary incontinence of protrusion into the vagina is present. If this does not happen, the related symptoms are likely to worsen.

Ulceration of Rectal Tissue

Some patients are too sick, or the prolapse is too small to treat with surgery. Rectal prolapse does not turn into cancer if left untreated. It is possible for the prolapsed rectal mucosa to become thickened and even ulcerated over time. If a patient has surgery, they usually recover well, and their quality of life improves. The recovery time is several weeks during which time patients should add fiber to their diets, avoid straining with bowel movements and extended periods of standing. One or two follow-up visits are likely to be needed to check that incisions are healing and bowel movements getting normal.