Rectal prolapse refers to the protrusion of the mucous membrane of the rectum (the most distal end of the intestines) through the anus, the opening from the intestines to the outside of the body. It is related to increased abdominal pressure, as when straining with a bowel movement; weak pelvic or rectal muscles; and a weak anal sphincter (the ring of muscle that keeps the anus closed). It is most common in adults over age 60, especially women. It also occurs in infants and may be an early sign of cystic fibrosis. There is an increased risk with some neurological diseases and in the bedridden.

Symptoms may include:

• Protrusion of the mucosa of the rectum, usually only when straining
• Bowel incontinence (loss of voluntary control)
• Poor tone of the anal sphincter
• Rectal bleeding, bloody diarrhea and abdominal pain
• Sensation that the bowel is full, even when it is not

WHAT YOUR DOCTOR CAN DO:

• Diagnose rectal prolapse by asking about your symptoms and doing a physical examination. You may be asked to squat for the exam. The protrusion usually occurs in this position.
• Order additional diagnostic procedures such as a barium enema which allows for special x-rays to be taken, or an endoscopy (use of a long, thin, flexible tube with a light and optics to view and take tissue samples inside the rectum)
Treatment depends on the cause and the symptoms:
• Eliminating the straining may be all that is necessary. For constipation, stool softeners and a high-fiber diet may be recommended
• Your doctor may recommend exercises to strengthen the weak muscles
• Your doctor may also manually manipulate rectum back into place in minor cases.
• Surgical repair may be recommended. There are several different procedures that are used

WHAT YOU CAN DO:

• Discuss your treatment options with your doctor. Be certain you understand the advantages and drawbacks of each.
• Follow your doctor's instructions for muscle-strengthening exercises
• Increase the bulk in your diet with high-fiber foods. This includes whole grain breads and cereals, beans and peas, and fresh, raw fruits and vegetables. To prevent abdominal bloating and gas, increase fiber slowly rather than all at once.
• Increase fluids (especially water) in your diet to at least 8 glasses a day.
• Lose weight if you are overweight.
• Avoid straining, as in coughing or lifting heavy objects
• Avoid taking laxatives other than what your doctor recommends.

WHAT YOU CAN EXPECT:

• Treatment is usually very effective.
• Complications following surgery may include incontinence of the bowel, infection, or abnormal bleeding.

CALL 1061 OR SEEK IMMEDIATE MEDICAL ASSISTANCE If you have symptoms of Rectal prolapse, if symptoms worsen despite treatment, or if they recur. After surgery, report any signs of infection or unusual bleeding.