Prolapse occurs when internal tissues protrude through the anus.
Rectal or anal prolapse is often so embarrassing that many suffering patients unfortunately do not seek help from a doctor. The condition mainly occurs in people who strain very hard to evacuate their bowels and in people with weakened pelvic muscles. Prolapse starts with only a little tissue protruding out of the anus and with time more and more tissue can abnormally bulge out and patients often have to then manually push their rectum back in with their hands, especially after defaecation.
The condition can give the same symptoms as haemorrhoids or more worrying conditions and it is important to seek a correct diagnosis from your doctor who may ask for specialist help from a colorectal surgeon. The main symptoms of prolapse are feelings of protusions out of the anus, constipation, bleeding and excess mucous production at the anus.
There are many helpful treatments. Initially the root cause should be focussed on. Strainers need to be educated that it is not always necessary to completely evacuate the rectum when defaecating. Diet changes can help by taking an extra glass of water a day and increasing dietary fibre. Sometimes a prescription of a laxative is required to make stool evacuation easier. Patients often defaecate to suit their busy lifestyles and they need to be educated that they should only go to the toilet when their body gives them the sensation that they need to open their bowels rather than straining hard at other times to fit in with daily commitments such as travelling on a train. Other patients get abnormal sensations that they have something to pass but they should stop straining if no stool is quickly forthcoming and wait till later.
Patients with weak muscles are often encouraged to perform pelvic floor exercises to ‘body-build’ the supporting muscles around the anus and the rectum. This also can help with bladder and vaginal problems. Patients with weak muscles are often women who have experienced pelvic muscle damage during childbirth or elderly patients who have lost muscle bulk with age.
In some patients surgical techniques can help. The mildest cases may require banding in the clinic where small plastic bands pull up prolapsing tissue back in to the rectum. Sometimes stapling guns can help with small prolapses. Larger prolapses often require excision of the prolapse using operations such as Delormes or Altmeiers which are performed through the anus. There are also now newer laparoscopic or keyhole techniques where instruments are inserted in to the abdomen to fix the prolapse internally. A colorectal surgeon should be able to give further information about this.
Although anal or rectal prolapse is embarrassing, there are a lot of helpful techniques available and I would urge you to seek help from a specialist doctor if you have problems with prolapse. Your local GP (general practitioner) will be able to help you do this.