It is a downward slippage of the rectum from its position that leads to protrusion through the back passage. The prolapse can be internal and is found during an internal examination, or external where a lump can be seen coming out of the anus. It might be associated with prolapse of other pelvic organs like the womb (uterus), bladder, top of the vagina, and small bowel as well.
The first thing you will notice is a lump sticking out of your back passage (anus). In the early stages this will only appear after you've had a poo or strained to pass a motion. It tends to disappear when you stand up. Later on, you may notice the lump in other circumstances that involve straining, like coughing or sneezing. Eventually, the lump may be noticeable most of the time and interfere with day-to-day activities such as walking. You may have to push the lump back with your hand.
With internal prolapse you might not see or feel a lump, but instead you might experience
symptoms like feeling of heaviness around the lower tummy or in the pelvis. It can also give you problems in passing motions, or leaking small amount of stool or urine.
Initial treatment for early stages includes life style changes such as losing weight, preventing or treating constipation and pelvic floor exercises. Surgery will be required if non-surgical options have not worked or if the prolapse is more severe. Surgical repair can be done by abdominal procedures or through perineal procedures.
Abdominal procedures: Involving opening the tummy or by keyhole surgery. The basic procedure is called a rectopexy, which involves placing the lower part of the bowel (the rectum) back into its original position and fixing it so it doesn't slip down again. Various methods are used to prevent slippage, including sutures, staples, slings and shortening the stretched bowel. This is most commonly done as keyhole surgery.
Perineal procedures: These involve surgery in the area of the perineum which is located between the anus and testicles in men or the anus and lower part of the vagina in women. Variations include stripping some of the lining of the bowel off the prolapse, bunching up the bowel muscles with stitches, then replacing the lining (Delorme's procedure). The other option is pulling the rectum through the anus, removing a portion of the rectum and sigmoid colon, and stitching up the end of the bowel to the anus (Altemeier’s operation / perineal rectosigmoidectomy).