A rectal prolapse occurs when the wall of the rectum, which is the final section of the large intestine, slides out of place and protrudes through the anus. While a person may be able to temporarily push the tissue back inside, this condition is a sign of an underlying issue, such as weakened pelvic floor muscles or chronic straining, and requires immediate follow-up medical consultation. Self-reduction is a temporary measure and is not a substitute for professional medical advice to diagnose the cause and prevent recurrence.
Essential Steps Before Attempting Reduction
The first step before attempting to reduce the prolapse is to ensure a clean environment to minimize the risk of introducing bacteria. Thoroughly wash your hands with soap and water for at least twenty seconds, and then put on a pair of clean, non-latex examination gloves. This barrier protects both the patient and the person assisting with the reduction from potential infection.
Positioning the body correctly helps to relax the pelvic floor and uses gravity to assist the reduction process. The patient should lie on their back with their knees drawn up toward the chest, or on their side in a comfortable fetal position. Taking slow, deep breaths can help the patient relax the anal sphincter muscle, which is often a barrier to successful reduction.
If the prolapsed tissue appears swollen, applying a cold compress wrapped in a clean cloth may help reduce the swelling. Granulated sugar can also be applied, as it acts as an osmotic agent, drawing water out of the swollen tissue. After reducing swelling, generously apply a sterile, water-soluble lubricating jelly to the entire surface of the protruding tissue to help it slide smoothly and prevent friction damage during reduction.
The Technique for Manual Reduction
Once the area is prepared and lubricated, the physical process of reduction can begin with gentle, steady action. Use the pads of your fingers or the palm of your hand to apply continuous, even pressure to the end of the protruding mass. The goal is to invert the tissue, meaning the part that came out last should be the first part to go back in, like pushing a sock back through itself.
The pressure applied must be firm enough to move the tissue but never sudden or jerky, as this can cause trauma or tearing. Direct the continuous pressure toward the center of the anal opening, following the natural curvature of the anal canal. Maintaining this steady pressure for several minutes is often necessary, as the anal sphincter muscle may be tight and resistant.
A common technique involves placing two thumbs flat against the prolapse and pressing inward, or alternating pressure from side to side to milk edema out of the tissue. As the tissue begins to retract, maintain gentle pressure to guide it fully back into the rectum. Encouraging the patient to continue breathing deeply and avoid straining is helpful, as sphincter relaxation is key to success.
Once the entire mass is fully inverted and no longer visible outside the anus, remove your hand slowly. Encourage the patient to remain resting in a position that reduces abdominal pressure, such as lying down, and contact a healthcare provider immediately to arrange for definitive treatment.
Warning Signs and When to Seek Emergency Care
While manual reduction is a common first-aid measure, specific warning signs indicate the need for immediate emergency medical intervention. If the prolapsed tissue appears black, dark purple, or severely dusky in color, this suggests that the blood supply has been compromised, a condition known as strangulation. Strangulated tissue is a medical emergency that can lead to tissue death, or necrosis, and requires professional treatment.
Manual reduction should be abandoned immediately if the patient experiences sudden, severe, or escalating pain during the attempt. Pain can be a sign of tissue damage, an incarcerated hernia, or other complications that require a physician’s assessment. Furthermore, if there is excessive or uncontrolled bleeding from the prolapsed tissue, do not continue the reduction attempt and seek emergency care.
The inability to reduce the prolapse after a few gentle, persistent attempts signals the need for professional help. Continued forceful attempts can cause significant trauma to the delicate mucosal tissue, increasing the risk of perforation or severe injury. If the prolapse remains outside the body, the patient should be transported to an emergency department for manual reduction under sedation or surgical intervention.