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Gynecology & Obstetrics

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Rectal Prolapse

What is Rectal Prolapse?

Rectal prolapse is a protrusion of the tissue of the rectal wall through the anal canal. In severe cases, this circular ring of rectal wall protrudes through the anus and outside the body. The protruding tissue may be visible or palpable, especially during defecation.

In more mild cases, the upper rectum protrudes into the lower rectum but remains inside the woman's body. Rectal prolapse may be associated with constipation, difficult defecation, and anal incontinence.

Diagnosing Rectal Prolapse

This condition may be diagnosed during a gynecologic examination or with a rectal examination (when the physician inserts a finger into the rectum). In some cases, the prolapse may not be evident until the woman is asked to bear down or strain.

In some cases, a defecography X-ray or MRI study may be required to diagnose this condition. Other tests to evaluate rectal prolapse may include colonoscopy (looking inside the colon with a scope or camera) and anal manometry (measures of pressure in the rectum and near the anal opening).

Defecography is performed to identify the position of the pelvic organs and to determine whether the organs descend significantly during defecation or bearing down.

How to Prepare for a Defecography

  1. Preparation for this test includes laxatives and/or enemas to clean out the colon.
  2. Before the X-ray pictures are taken, a special fluid is instilled into the bladder through a catheter so that the bladder will show up on the x-ray pictures. A special gel is placed into the vagina for the same purpose. A paste is placed into the rectum, again to allow the position of the rectum to be visible on the x-ray pictures.
  3. The woman sits on a special chair or commode as X-ray pictures are taken. She is then asked to bear down or defecate (expel the paste from her rectum) as X-ray pictures are taken.
  4. The series of pictures allows the radiologist to measure any shift or descent in the pelvic organs and the perineum. In some circumstances, we recommend a similar test using Magnetic Resonance Imaging (MRI) instead of X-rays.

Treatment Options

Rectal prolapse is generally treated with surgery. The nature of the recommended surgery will depend on the:

  • Type and degree of the prolapse
  • Woman's overall health
  • Associated bowel function problems

In many cases, a suspension of the rectum is recommended, in which the rectum is attached to strong ligaments inside the pelvic cavity. A segment of the colon may be removed in some cases.

At Johns Hopkins, our physicians are experienced at evaluating and treating rectal prolapse. Your physician will discuss different treatment options with you and refer you to an experienced surgeon if necessary.