Rectal Prolapse

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Rectal prolapse is a condition where the rectum, the last part of the large intestine, slips out of its normal position and protrudes through the anus.

This happens when the muscles and tissues that support the rectum weaken and cannot hold it in place. It can cause discomfort, bowel control issues, and, in more severe cases, complications like bleeding or incontinence. Treatment often depends on the severity and underlying causes, ranging from lifestyle changes to surgery.

Causes and Risk Factors

Rectal prolapse is primarily caused by weakened pelvic muscles, which can be caused by a number of factors, including:

Chronic Constipation

Repeated straining during bowel movements can place excessive pressure on the rectum, weakening the muscles over time and increasing the risk of prolapse.

Muscle Weakness

Ageing, pregnancy, and childbirth can stretch or weaken the pelvic muscles, reducing their ability to hold the rectum securely. The condition is more common in older adults and women with multiple pregnancies.

Nerve Damage

Conditions that cause damage to the nerves controlling the rectum, such as spinal injuries or neurological disorders, may impair muscle function. This can lead to weakened support around the rectum, making it more prone to prolapse.

Chronic Straining

Activities that require repeated heavy lifting, chronic coughing, or the physical strain of childbirth can increase abdominal pressure, pushing the rectum out of position.

Diagnosis of Rectal Prolapse

Diagnosing rectal prolapse involves a thorough evaluation to confirm the condition and develop an effective treatment plan. Key steps include:

Physical Examination

The doctor examines the anal area and may ask the patient to strain as if having a bowel movement. This helps to determine whether the rectum protrudes and the extent of the prolapse.

Imaging Tests

Imaging tests such as defecography (X-ray taken during straining) or MRI scans may be used if the prolapse is internal or not clearly visible. These tests provide a detailed view of rectal positioning, muscle function, and any tissue displacement, which helps in assessing the severity.

Colonoscopy

A colonoscopy may be performed to examine the inner lining of the rectum and colon. It helps rule out other conditions with similar symptoms, such as tumours, polyps, or inflammatory bowel disease, ensuring accurate diagnosis.

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Treatment Options for Rectal Prolapse

The choice of treatment depends on the severity of the prolapse and the patient’s overall health. Non-surgical methods are often effective for mild cases, while surgical interventions are typically needed for more severe or persistent prolapse.

Non-Surgical Treatment
Pelvic Floor Exercises

These exercises help strengthen the muscles around the rectum, improving support and potentially preventing further prolapse. Often recommended for mild cases, they can also be part of post-surgical recovery to maintain muscle strength.

Stool Softeners and Dietary Changes

Adjustments such as increasing fibre intake and using stool softeners can reduce straining during bowel movements, lowering the pressure on the rectal area. This may help manage symptoms and prevent the condition from worsening.

Surgical Treatment
Rectopexy

Rectopexy is a common procedure used to secure the rectum back in its proper position. The rectum is lifted and attached to the sacrum (lower part of the spine) using sutures or mesh. This procedure reinforces the support structure of the rectum, reducing the likelihood of future prolapse.

Rectopexy can be performed using traditional open surgery or minimally invasive techniques, such as laparoscopic or robotic-assisted surgery, which may offer quicker recovery times and reduced post-operative pain.

Resection

In cases where the prolapse is associated with chronic constipation or when a significant portion of the bowel is affected, a bowel resection may be necessary. This procedure involves removing a section of the colon (part of the large intestine) to improve bowel function and alleviate symptoms like chronic constipation.

Resection is often combined with rectopexy to provide a comprehensive repair. The specific type of resection performed depends on the individual patient’s condition and the surgeon’s assessment.

Preventing Rectal Prolapse

Preventing rectal prolapse involves lifestyle habits that reduce strain on the pelvic area. Maintaining a fibre-rich diet with fruits, vegetables, and whole grains can prevent constipation, minimising the need to strain during bowel movements. Regular pelvic floor exercises help strengthen muscles, offering better rectal support. Additionally, avoiding heavy lifting or intense physical activities and managing chronic conditions like persistent constipation or coughing are necessary in lowering the risk of developing rectal prolapse.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    Can rectal prolapse resolve on its own without treatment?

    No, rectal prolapse generally does not go away on its own. Mild cases may be managed with lifestyle changes, but moderate to severe prolapse usually requires medical intervention to prevent worsening.

    What are the risks if rectal prolapse is left untreated?

    If rectal prolapse is not treated, it can lead to complications such as chronic discomfort, bowel incontinence, and worsening of symptoms. Severe cases may cause ulceration of the exposed rectal tissue or strangulation, where the blood supply to the prolapsed rectum is compromised, requiring emergency surgery.

    Can rectal prolapse recur after surgery?

    Yes, there is a risk of recurrence even after surgery, though it is lower with procedures like rectopexy. Factors such as age, general health, and adherence to post-surgical lifestyle recommendations can influence the likelihood of recurrence.

    How long is the recovery period after surgery for rectal prolapse?

    Recovery typically takes about 4 to 6 weeks, depending on the type of surgery and the patient’s overall health. During this period, patients must avoid strenuous activities and heavy lifting, gradually resuming normal activities as advised by their doctor. Following specific aftercare instructions, such as dietary modifications and proper wound care, is necessary to support healing and minimise the risk of complications.

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