Clinical manifestations of rectal prolapse

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 19, 2024
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The clinical manifestations of rectal prolapse mainly involve the contents within the anal canal, especially the prolapse of the rectal mucosa outside the anus, which is most common. Severe cases of rectal prolapse may lead to a cylindrical or conical prolapse. The common type of rectal prolapse mainly refers to rectal prolapse, but there can also be internal prolapse of the rectal mucosa. Internal prolapse of the rectal mucosa is characterized by excessive relaxation and accumulation of the rectal mucosa at the anus, causing symptoms such as a sense of blockage, downward pressure, and obstruction during bowel movements. This can be definitively diagnosed through an anal examination and defecography. Regardless of whether it is internal prolapse of the rectal mucosa or rectal prolapse, when the disease progresses to a severe degree affecting the patient's normal life, surgical treatment is recommended.

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Written by Chen Tian Jing
Colorectal Surgery
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Causes of rectal prolapse

The causes of rectal prolapse primarily include older age or physical weakness leading to relaxation and sagging of the pelvic and rectal mucosa. Prolonged constipation can also lead to excessive straining during bowel movements, causing stress-induced sagging of the intestinal mucosa. Additionally, women who have gone through childbirth may experience rectal prolapse due to excessive straining of the pelvic floor muscles during delivery or increased abdominal pressure during pregnancy, which compresses the rectal mucosa. The treatment for rectal prolapse mainly consists of conservative medication or surgical removal. For mild cases of rectal prolapse, including those in children, traditional Chinese medicine enemas can be used. However, for moderate to severe cases, or cases where prolapse recurs frequently and significantly forms a complete prolapse, surgical removal is recommended.

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Written by Deng Heng
Colorectal Surgery
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Can rectal prolapse cause bleeding during bowel movements?

Patients with rectal prolapse may experience bleeding during bowel movements. The primary symptom of rectal prolapse is a protrusion of a swelling through the anus. Initially, the swelling is small and only protrudes during bowel movements, retracting on its own afterwards. As the condition progresses, due to a lack of contraction strength in the levator ani and anal sphincter muscles, the prolapse occurs more frequently and increases in size, requiring manual repositioning back into the anus after defecation. If not repositioned timely, the prolapsed intestinal tract can become edematous, constricted, or even necrotic, which may result in bloody stools.

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Colorectal Surgery
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Can rectal prolapse heal itself?

Rectal mucosal prolapse primarily refers to a condition where the rectal mucosa becomes excessively relaxed, accumulates near the anus, and presents symptoms such as a distinct feeling of fullness and downward pressure at the anal area. Sometimes, the prolapsed mucosa may congest the anal opening, causing difficulty in defecation or even constipation. Rectal mucosal prolapse cannot heal completely on its own. Treatment options include medication to alleviate symptoms or surgery to remove the prolapsed mucosa. Patients with rectal mucosal prolapse should avoid straining excessively during bowel movements. If constipation occurs, patients should not strain too hard and may use enemas to assist with bowel movements.

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Colorectal Surgery
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Can you have children with rectal prolapse?

If a patient is diagnosed with rectal prolapse, they can still have children. However, childbirth can potentially worsen rectal prolapse, especially during natural delivery, where excessive straining in the pelvic and anal areas can exacerbate the condition. Therefore, if a patient already has rectal prolapse, it is advised to consider surgical removal treatment before pregnancy. If rectal prolapse occurs during pregnancy, external wash medications and hot compresses can be used to promote retraction. If rectal prolapse occurs during delivery, surgical treatment can also be carried out after childbirth. However, it is recommended that patients with severe rectal prolapse undergo cesarean delivery to avoid the excessive strain during natural childbirth, which could worsen the prolapse.

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Rectal prolapse treatment

Rectal prolapse is primarily categorized into mild rectal prolapse as well as moderate and severe rectal prolapse. Mild rectal prolapse generally occurs in the early stages of the illness or in children and can be treated conservatively. Conservative treatment mainly involves Chinese herbal retention enemas. On the other hand, moderate and severe rectal prolapse can result in the protrusion of the local mucosa outside the anus, presenting as cylindrical or cone-shaped prolapses. Treating moderate to severe hemorrhoidal prolapse requires surgical intervention. The main surgical methods include hemorrhoidal mucosectomy with stapling and local submucosal sclerosant injections. It is also important to caution postoperative patients against squatting for long periods or straining during constipation, as these actions can exacerbate symptoms of submucosal prolapse.