External Rectal prolapse

What is rectal prolapse?
Rectal prolapse occurs when the lower part of the bowel, the rectum, becomes stretched and protrudes out from the anus.

What causes rectal prolapse?
Most commonly, this is caused by a weak pelvic floor from ageing and childbirth even though it may only come to light many years later. Men and women with long term constipation and straining also seem to be at risk of the condition.

What symptoms do patients get?
Most patients are aware of a lump protruding from the anal canal when they strain. In some patients, this is present all the time. The condition is often associated with a weak sphincter muscle and most patients suffer with faecal incontinence and/or obstructed defaecation.

Which tests will I need?
Often the diagnosis is easily made as the lump is obvious on examination. At other times, we will examine you after you have strained on the toilet or commode in order to make the prolapse “come down”. Anorectal physiology and endoanal ultrasound are very useful as a baseline assessment of sphincter function. Often a proctogram is helpful.

Which treatments might be offered?
The best treatment for almost all patients with rectal prolapse is surgery. Usually this is in the form of a laparoscopic ventral rectopexy, which is a key-hole operation that hitches up the bowel from above and fixes it using a mesh, made from artificial material. Occasionally, in less fit patients, the prolapse is fixed through the anal canal, though this approach tends to be less durable.