Rectal prolapse is a condition where the rectum, the final section of the large intestine, slips out of its normal position and sometimes protrudes through the anus. This causes discomfort, bleeding, and issues with bowel control. While the physical symptoms can be alarming, effective medical and surgical interventions are widely available. Finding the right medical professional is crucial for diagnosis and definitive treatment.
Understanding Rectal Prolapse
Rectal prolapse occurs when the supporting muscles and ligaments around the rectum weaken, allowing the bowel wall to telescope out through the anal opening. Prolapse is differentiated as partial (mucosal), involving only the inner lining, or full-thickness, involving the entire wall extending outside the body.
Common symptoms include a sensation of fullness, the visible protrusion of a reddish mass outside the anus, and the leakage of mucus, blood, or stool. The condition is often linked to chronic straining during bowel movements, which can be caused by long-term constipation or diarrhea. Age-related weakening of the pelvic floor muscles and prior trauma, such as from childbirth, are also contributing factors in many cases.
The Primary Specialists Who Treat Rectal Prolapse
Definitive treatment for rectal prolapse, especially full-thickness cases, typically involves surgery, making a surgical specialist the most appropriate provider. The most qualified professional is a colorectal surgeon, sometimes referred to as a colon and rectal specialist. These physicians possess specialized training focused exclusively on the colon, rectum, and anus, including complex surgical procedures.
Colorectal surgeons are the experts in performing surgical repairs, such as rectopexy, which involves pulling the rectum back into place and securing it to the sacrum. They are adept in both open and minimally invasive techniques, including laparoscopic and robotic-assisted surgery, which often result in faster recovery times. They tailor the surgical approach based on the patient’s overall health and specific bowel function issues.
While a colorectal surgeon is the specialist of choice, general surgeons also play a role, particularly in smaller healthcare settings. Many general surgeons are trained to perform abdominal or perineal repairs for rectal prolapse, especially in less complicated cases. They provide a necessary surgical option when a colorectal specialist is not immediately available.
Gastroenterologists often serve as the initial point of contact for patients presenting with related symptoms. Their role is primarily diagnostic, helping to differentiate rectal prolapse from other conditions like hemorrhoids or polyps. They may manage non-surgical aspects, such as optimizing bowel habits and treating chronic constipation, which can worsen the prolapse.
Diagnostic and Treatment Pathways
Diagnosis generally begins with a physical examination, where the physician asks the patient to strain as if having a bowel movement. This action makes the prolapse visible for confirmation and differentiation from hemorrhoids, which have radial folds compared to the concentric folds of a full prolapse. Further diagnostic tools evaluate the extent of the prolapse and rule out other diseases.
Defecography is a specialized imaging test that captures the mechanics of the rectum and pelvic floor muscles during defecation, helping to identify an internal prolapse or other hidden pelvic floor issues. A colonoscopy may also be performed to visualize the entire colon and rule out conditions like polyps or cancer that could mimic or contribute to the symptoms.
Treatment for adult rectal prolapse is largely surgical, though mild, early cases can sometimes be managed non-surgically. Non-operative management focuses on increasing dietary fiber, using stool softeners, and performing pelvic floor exercises to strengthen the supporting muscles. This approach is most often considered for frail patients or those who are poor candidates for surgery.
For full-thickness or symptomatic prolapse, surgical intervention is required. The two main surgical pathways are the abdominal approach and the perineal approach. Abdominal repair, such as a rectopexy, is typically preferred in younger, healthier patients due to a lower chance of recurrence. The perineal approach, performed through the anus, is often chosen for elderly or less healthy patients because it is generally less invasive with a quicker recovery, despite a slightly higher risk of recurrence.