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Rectal prolapse occurs when the rectum, the last part of the large intestine, slips out of its normal position and protrudes through the anus.
This occurs due to the weakening of the muscles and connective tissues that support the rectum, leading to various symptoms and complications if left untreated.
Prolapse causes the rectum to protrude through the anus, which can result in a variety of symptoms. Key symptoms include:
Visible Protrusion: Because of weakened muscles and connective tissues, the rectum slips out of place, causing a visible bulge outside the anus. The protruding tissue may be visible when standing, walking, or straining, and it may retract on its own or require manual pushback.
Discomfort and Pain: The prolapsed rectum puts pressure on surrounding tissues, causing pain or discomfort, which can worsen with activities like sitting or bowel movements.
Bleeding or Mucus Discharge: When the inner lining of the rectum is exposed, it becomes irritated, leading to bleeding or mucus secretion. This may lead to itching, soreness, or skin irritation around the anus.
Incontinence or Constipation: Prolapse-related nerve and muscle dysfunction can cause difficulty controlling bowel movements (incontinence) or passing stools (constipation) because the rectum is not functioning properly. Some individuals may have difficulty passing stools without manually supporting the prolapsed tissue.
Rectal prolapse is often the result of weakened pelvic floor muscles and connective tissues. Several factors can contribute to this condition:
Regular straining during bowel movements puts pressure on the rectal muscles, causing gradual weakening that can eventually lead to prolapse.
Factors such as ageing, pregnancy, and childbirth can stretch or damage pelvic floor muscles, increasing the risk, especially in older adults and women with multiple pregnancies.
Damage to the nerves controlling the rectum can prevent proper muscle function. This may be due to spinal injuries, neurological disorders, or long-term conditions like diabetes.
Activities that lead to frequent straining, such as chronic coughing, heavy lifting, or even childbirth, can increase the risk of rectal prolapse by putting excessive pressure on the abdominal area.
Diagnosing rectal prolapse involves a comprehensive evaluation to confirm the condition and plan appropriate treatment.
A doctor will conduct a physical exam by asking the patient to strain as if having a bowel movement. This allows the physician to observe if the rectum protrudes from the anus and to evaluate the extent and whether it is partial or complete.
If the prolapse is not easily visible, imaging tests like defecography or MRI scans may be used. Defecography captures X-ray images during bowel movements to show muscle function, while MRI provides detailed images of soft tissues, highlighting any structural weaknesses or misalignments.
A colonoscopy involves inserting a thin, flexible tube with a camera into the rectum to inspect the inner lining of the rectum and colon. This procedure helps identify or rule out other conditions, such as tumours, polyps, or inflammatory diseases, to ensure an accurate diagnosis and guide appropriate treatment.
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Treatment varies based on the severity of the prolapse and the patient’s overall health and aims to relieve symptoms, restore normal rectal function, and prevent recurrence.
Non-surgical approaches are suitable for mild cases of rectal prolapse.
Pelvic floor exercises help strengthen the muscles surrounding the rectum, enhancing support and reducing the risk of further prolapse. These exercises are often recommended for those with mild symptoms or as part of post-surgical recovery to maintain muscle tone. Improved muscle strength provides better rectal support, potentially preventing future prolapse.
Surgery is considered for severe or persistent cases where non-surgical methods are ineffective.
This procedure involves lifting the rectum and securing it to the sacrum (lower spine) using sutures or mesh. Rectopexy helps restore the rectum’s normal position, reducing the risk of further prolapse and improving bowel function. It is commonly performed for cases of external prolapse, where the rectum visibly protrudes through the anus.
For severe cases involving a large portion of the colon, resection may be necessary. This surgery removes part of the colon and is often combined with rectopexy to alleviate symptoms such as chronic constipation, which can worsen prolapse. By shortening the bowel, the procedure improves bowel movements and decreases the risk of recurrence.
Preventing rectal prolapse focuses on reducing strain on the pelvic area through healthy lifestyle practices. Eating a fibre-rich diet, including fruits, vegetables, and whole grains, helps prevent constipation and minimises straining during bowel movements.
Regular pelvic floor exercises strengthen muscles around the rectum, providing better support. Staying physically active promotes overall bowel health, and avoiding heavy lifting or activities that increase abdominal pressure reduces the risk of prolapse or worsening an existing condition.
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*Extended Panel
MbChB (Sheffield)
M.Med (Surgery)
FRCSEd (General Surgery)
蘇萊曼·尤索夫博士
Dr. Sulaiman Yusof is a distinguished Senior Consultant in colorectal and general surgery, boasting over 15 years of expertise. His passion lies in minimally invasive techniques, particularly robotic surgery, where he has achieved remarkable success using the Da Vinci Xi system. Dr. Sulaiman is dedicated to delivering high-quality, personalized, and empathetic care, always striving for the best outcomes for his patients.
Dr. Sulaiman’s journey began at the University of Sheffield, where he graduated in 2002. He honed his skills during his house officer and basic surgical training in the UK before returning to Singapore. There, he completed his Advanced Surgical Training at Changi General Hospital and earned the Joint Speciality Fellowship in General Surgery in 2013.
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Although both conditions involve tissue protruding from the anus, they are distinct. Rectal prolapse occurs when the rectum slips out of place, while haemorrhoids are swollen blood vessels in the anal region. Because they have different causes, the treatments and management strategies vary.
Rectal prolapse is relatively uncommon in children but can occur, often due to chronic strain from constipation. The condition is far more prevalent in adults, particularly in older individuals and women who have had multiple pregnancies, due to age-related muscle weakening and physical strain.
No, rectal prolapse typically does not resolve on its own. Mild cases may be managed with lifestyle changes, but severe or persistent cases usually require medical intervention to prevent further complications.
Leaving rectal prolapse untreated can result in chronic discomfort, incontinence, and potential damage to the rectal tissue from prolonged exposure. Over time, the condition may deteriorate, often requiring more extensive and invasive treatment.