The rectum is the last part of the large intestine and is held in place by muscles and ligaments of the pelvis. When these muscles and ligaments weaken, the rectum may slip and turn inside out of the anus. This is called rectal prolapse. Rectal prolapse may lead first to constipation and later, to fecal incontinence, the inability to control bowel movements.
Signs and symptoms of rectal prolapse
A patient may experience one or more of the following symptoms:
- Straining during bowel movements
- Tissue protruding from the anus
- Late fecal incontinence
Diagnosis will include the following:
- A complete medical history and a thorough physical examination.
Your surgeon may order a series of tests that will help to confirm a diagnosis of rectal prolapse and fecal incontinence. These may include:
- Digital Rectal Examination (DRE). Your surgeon will perform this test in the office during your physical examination. Your doctor will insert a gloved finger into the rectum to examine the rectum.
- Your surgeon may ask you to sit on the toilet and push down as if you were having a bowel movement so that the rectal prolapse may be seen.
- In some patients, the rectal prolapse cannot be directly observed. Using a defecating proctogram, a series of X-rays show the mechanics of the bowel movements, and the internal rectal prolapse is seen.
- Anorectal manometry is a test that measures the strength of the sphincter muscle.
- A lower endoscopy is performed to verify there is no other disease.
Treatment for rectal prolapse usually involves surgery, as the prolapse will not self-correct. See our list of abdominal surgeries.
For active patients, abdominal surgery to correct rectal prolapse is performed. The rectum is dissected free from the pelvic connections and is pulled up into its normal position and fixed to the sacral bone.
For older patients, an approach from the bottom may be used, but the recurrence of rectal prolapse is more frequent. In one approach, the prolapsed rectum is cut off and rejoined. In another approach, the lining of the rectum is dissected off and the remaining muscle is pleated and folded up inside.
Fecal incontinence is due to weakened sphincter muscles or injury to the nerves that serve these control muscles. This disorder is most often due to injury associated with childbirth.
Different degrees of fecal continence are denoted by the ability to control gas, liquid stool, or solid stool.
To complete a diagnosis:
- Your surgeon will obtain a complete medical history and a conduct a thorough physical examination.
Your surgeon may order a series of tests that will help to confirm a diagnosis of fecal incontinence. These may include:
Digital Rectal Examination (DRE). Your doctor will insert a gloved finger into the rectum to examine the rectum. The surgeon will perform this test in the office during your physical examination.
An anal ultrasound is performed to show the muscles and detect tears in muscles.
Pudendal nerve test to show the function of the nerves that serve the sphincter muscles.
Anorectal manometry to test the tone and strength of the control muscle.
A lower endoscopy is performed to verify there is no other disease.
Treatment for fecal incontinence includes:
- Correction of stool consistency aids control
- Biofeedback is physical therapy to strengthen weak muscles
- Torn and separated muscles may respond to repair of the muscle defect