Clinical manifestations of rectal prolapse

Written by Deng Heng
Colorectal Surgery
Updated on February 17, 2025
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The main symptom of rectal prolapse is a swelling that protrudes from the anus. In the early stages, the swelling is small and only protrudes during defecation, retracting on its own afterwards. As the condition progresses, the protrusion occurs more frequently and grows larger, requiring manual assistance to push it back into the anus after defecation. This is accompanied by a feeling of incomplete bowel evacuation and a feeling of heaviness. If not addressed promptly, the prolapsed intestine may become swollen, constricted, incarcerated, and even risk necrosis. As the prolapse worsens, it can cause varying degrees of anal incontinence, accompanied by the discharge of mucus, which leads to eczema and itching around the anal area.

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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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Will rectal prolapse cause the stool to become thinner?

Patients with rectal prolapse may experience a narrowing of their stool, which is primarily due to the relaxation of the rectal mucosa associated with rectal prolapse. The relaxed mucosa accumulates at the anus, blocking the passage of feces and thus altering the shape of the stool as it is expelled, generally resulting in thinner or flattened stools. Therefore, if it is definitively diagnosed that the change in stool shape is due to rectal prolapse, surgical treatment is recommended. The surgery involves excising or suturing the excessively relaxed rectal mucosa to allow for a smoother passage of stool and to prevent alterations in stool shape. Additionally, it is important for patients to maintain good lifestyle and bowel habits post-surgery, spend minimal time defecating, and avoid prolonged squatting or straining actions.

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What is the pathogenic mechanism of rectal prolapse?

The pathogenic mechanism of rectal prolapse primarily refers to the relaxation and sagging of the rectal mucosa down to the anal area, forming an internal rectal mucosa prolapse. Excessive relaxation of the rectal mucosa can protrude externally through the anus in a cylindrical or conical shape, commonly known as external rectal mucosa prolapse or rectal prolapse. The causes are mainly due to congenital deficiency of kidney energy in patients or excessive relaxation of the rectal mucosa due to multiple childbirths. Some patients with long-term constipation may also experience rectal mucosal relaxation due to excessive straining during bowel movements. Additionally, elderly and frail patients may experience sagging of the rectal mucosa as they age.

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Can glycerin suppositories be used for rectal prolapse?

If a patient experiences difficulty in defecation or constipation due to rectal prolapse, enemas can be used to help facilitate bowel movements. The basic principle behind the defecation difficulties caused by rectal prolapse is due to the prolapsed, lax mucosa blocking the anal opening, preventing normal excretion of stool. Alternatively, when excretion does occur, it may be impeded by the mucosal obstruction, obstructing the normal passage of feces. Therefore, besides using enemas to address difficulty in defection and bowel movement, it is more necessary to surgically remove the lax mucosa to achieve a fundamental treatment. The use of enemas alone can only provide temporary relief of symptoms and does not address the root cause of the problem. For rectal mucosal prolapse, a stapled hemorrhoidopexy can be performed to surgically remove the prolapsed mucosa.

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Is rectal prolapse the same as hemorrhoids?

Rectal prolapse and hemorrhoids are two different diseases. Rectal prolapse refers to the condition where the rectal mucosa, or sometimes the entire rectal wall, prolapses downwards during defecation, prolonged standing, or fatigue, especially in severe cases. Hemorrhoids, on the other hand, involve the prolapse of vascular cushions and anal padding, sometimes accompanied by symptoms like rectal bleeding. The causes, mechanisms, pathology, symptoms, and treatment methods of these two conditions are distinct, making rectal prolapse and hemorrhoids two separate diseases.