Rectal Prolapse

In a rectal prolapse the rectum loses its attachments and slides down, so that part of it turns inside out and comes through the anus. A partial prolapse is the lining alone; a full-thickness prolapse is the whole wall, and appears as a red tube with rings around it.

It develops over years, usually from long-standing straining, and it is far commoner in older women, in whom childbirth and pelvic floor weakness have already loosened the supports. Chronic constipation, chronic cough and neurological conditions all contribute. It also occurs in small children, where it usually settles as they grow and is managed quite differently.

At first it comes down only when you strain and goes back by itself. Later it comes down on standing or walking and has to be pushed back. The stretched anus leaks mucus and often stool, and for most people that leakage, and not the prolapse itself, is what makes daily life difficult.

A doctor confirms it by seeing it. That sounds obvious and it is the practical difficulty: the prolapse frequently will not appear during an examination on a couch. Expect to be asked to strain, sometimes sitting or squatting over a toilet, because a prolapse that has not been seen cannot be measured, and its length is what decides the operation.

They will also assess the tone of the sphincter, because how much control you have before surgery is a good guide to how much you will have after it, and because it changes what is offered alongside the repair.

A prolapse is often investigated further with a scan of the pelvic floor while you strain, and with a camera examination of the bowel. The second is looking for anything higher up that might be dragging the rectum down, particularly if the prolapse is new or you are over fifty.

Conservative measures work slowly. Fibre, stool softeners and supervised pelvic floor exercises take weeks to months, and they help a partial prolapse and not a full-thickness one.

The perineal operations, done through the anus, mean a few days in hospital and two to four weeks before you are back to normal. The abdominal keyhole operation is a bigger anaesthetic but a smaller recovery than it sounds: usually two to four days in hospital and three to four weeks to full activity.

Continence improves after surgery for most people, and it improves slowly, over six to twelve months, as the stretched muscle recovers tone. It does not always return completely, and your surgeon should say so before you decide. Avoiding straining afterwards is not optional; it is what caused this.