Rectal prolapse occurs when the rectum, the final section of the large intestine, turns inside out and protrudes through the anus, appearing as a reddish, fleshy mass. Initially, it may only occur during bowel movements and retract on its own. Over time, it can become more persistent, remaining outside the anus or occurring spontaneously with physical activity.
Managing Rectal Prolapse at Home
Manual reduction offers temporary relief but is not a cure and requires medical evaluation. Before attempting reduction, thoroughly wash your hands. Wearing disposable gloves can provide additional cleanliness.
Position yourself on your side with knees drawn to your chest, or in a knee-chest position. A cushion beneath the pelvis can use gravity to assist reduction. Apply lubricating jelly, like KY jelly, to the prolapsed tissue to reduce friction.
With clean, lubricated hands, apply gentle, steady pressure to push the tissue upward until it slips back inside the anal canal. If the prolapse is swollen, making reduction difficult, apply granulated table sugar. It acts as an osmotic agent, drawing out excess fluid to shrink the tissue within 15 minutes, making manual reduction easier.
After reduction, apply an ice pack to alleviate swelling and tenderness. Barrier creams, like those containing zinc, can protect the anal skin. Avoid activities that increase abdominal pressure, such as straining during bowel movements, heavy lifting, or vigorous coughing and sneezing, to help prevent recurrence. Addressing constipation or diarrhea through dietary adjustments also supports recovery.
When Immediate Medical Attention is Needed
While manual reduction provides temporary relief, certain situations require immediate medical attention to prevent serious complications. Seek prompt medical care if you cannot push the prolapse back inside, or if it re-prolapses immediately. Inability to reduce the tissue can indicate a more severe issue.
Urgent medical evaluation is needed for severe anal or rectal pain. A change in tissue color to dark red, purple, or black is a serious warning sign, suggesting strangulation. This medical emergency can lead to tissue death. Excessive bleeding or ulcers and open sores on the exposed tissue also require immediate professional assessment.
Understanding Causes and Preventing Recurrence
The exact cause of rectal prolapse is not fully understood, but several factors contribute to its development. Weakened pelvic floor muscles and supporting tissues are a primary cause, as they hold the rectum in position. Chronic constipation and persistent straining during bowel movements significantly increase risk by putting pressure on rectal support structures.
Age is another factor, with prolapse more common in individuals over 50, particularly women. Childbirth can also weaken pelvic floor muscles, increasing susceptibility. Other causes include chronic diarrhea, persistent coughing or sneezing, and certain neurological conditions affecting muscle control. A genetic predisposition may also exist.
Preventing recurrence or initial occurrence often involves adopting lifestyle modifications. A fiber-rich diet (25-35 grams daily from fruits, vegetables, and whole grains) promotes regular, soft bowel movements and prevents constipation. Adequate hydration (6-8 glasses of water or 1.5-2 liters daily) helps keep stools soft and easy to pass.
Avoiding straining during bowel movements is an important preventive measure, aided by proper toileting posture, such as using a footstool. Strengthening pelvic floor muscles through specific exercises can improve rectal support; consult a healthcare professional for guidance. Managing chronic conditions like persistent cough or diarrhea, maintaining a healthy weight, and avoiding heavy lifting can also reduce pelvic floor strain and lower prolapse risk.
Medical and Surgical Treatment Options
While home measures provide temporary relief, adults typically require professional medical intervention for permanent treatment. Non-surgical approaches focus on managing contributing factors like constipation or diarrhea with bulking agents, stool softeners, or laxatives. Physical therapy, including biofeedback, can also strengthen pelvic floor muscles and improve bowel function. In young children, rectal prolapse often resolves with conservative management and does not always require surgery.
Surgical procedures are categorized into two main approaches: abdominal and perineal. Abdominal procedures, like rectopexy, anchor the rectum to the sacrum, sometimes using mesh. These can be performed via open surgery, laparoscopically, or with robotic assistance. Abdominal approaches generally have lower recurrence rates but may involve more extensive recovery. Sometimes, a section of the colon may also be removed to address chronic constipation.
Perineal procedures, such as Altemeier or Delorme, are performed through the anus. They often involve removing the prolapsed rectal section and rejoining the remaining tissue. Perineal approaches are often preferred for older or frailer patients due to easier recovery, though they may carry a slightly higher recurrence risk than abdominal procedures. The choice of surgical approach depends on factors including the patient’s age, overall health, and prolapse severity.
Post-surgical recovery typically involves a high-fiber diet, adequate hydration, using stool softeners to prevent straining, and avoiding heavy lifting or strenuous activities for several weeks. These measures are important for proper healing and preventing complications.