Rectal Prolapse

Rectal prolapse is when the rectum — the last section of your large bowel — descends and slides out through the back passage (anus). It is more common in women, particularly older women, and is often linked to weakness of the pelvic floor — the group of muscles that support the bowel, bladder, and uterus. Chronic straining and constipation can contribute. It is important to distinguish a true full-thickness rectal prolapse from prolapsing haemorrhoids (piles that descend through the back passage) or mucosal prolapse (only the inner lining of the rectum slips down), because these are different conditions managed in different ways.

Full-thickness rectal prolapse is where the entire wall of the rectum — all its layers — protrudes through the back passage. This is what most people mean when they say "rectal prolapse." Internal rectal prolapse (intussusception) is where the rectum folds in on itself internally but does not yet come out through the back passage — you may feel a strong sense of incomplete emptying or a "blockage" sensation without anything visible. Mucosal prolapse is where only the innermost lining of the rectum slips down — it looks similar but requires different management.

The most noticeable symptom is a lump or protrusion coming out of the back passage — often after a bowel motion, but sometimes when you cough, sneeze, or stand up. It may slide back in on its own, or you may need to gently push it back. Other symptoms include a mucous or bloody discharge, a feeling that you have not emptied properly, and constipation. Over time, the repeated stretching caused by the prolapse can damage the sphincter muscles that control your bowel — leading to leakage or difficulty holding on (faecal incontinence). This is one of the important reasons to have a prolapse assessed and treated rather than simply managing it at home.

In most cases, the diagnosis is confirmed by examination — particularly if you are asked to strain down as if you are having a bowel motion, which allows the prolapse to be seen. Sometimes a more detailed assessment is needed. This may include anorectal manometry (a test that measures the pressures inside the anal canal — like a blood pressure test for your bowel), an endoanal ultrasound (an ultrasound probe gently placed inside the back passage to look at the sphincter muscles), or a proctography or MRI scan (imaging that watches how your bowel works while you strain — performed in a radiology department, with the scans reviewed in privacy).

For mild internal prolapse or early symptoms, pelvic floor physiotherapy can be genuinely helpful. For a full-thickness rectal prolapse that is causing symptoms, surgery is the most effective solution. The preferred surgical approach is a laparoscopic (keyhole) or robotic ventral mesh rectopexy (VMR). In this operation, the rectum is gently lifted back into its correct position and supported by a small synthetic mesh that is anchored to the bony sacrum (the base of the spine at the back of the pelvis). This relieves the prolapse, and in many patients also improves bowel control and continence. Success rates are high — around 90–95% in most series, with low recurrence, and the recovery from keyhole surgery is much quicker than from open surgery. For patients who are elderly or have health conditions that make abdominal surgery risky, there are alternative procedures performed through the back passage itself (the Altemeier or Delorme procedure) that avoid any abdominal incision at all.

Mr Nguyen's preferred approach for rectal prolapse is robotic-assisted ventral mesh rectopexy — a keyhole technique using a robotic system that allows very precise dissection in the narrow pelvis while avoiding a large abdominal incision. It is associated with excellent success rates, low recurrence, and good recovery of bowel function. This is performed at Warringal Private Hospital and Epworth Eastern. For patients who are frail or for whom abdominal surgery would carry too much risk, Mr Nguyen is experienced in the perineal Altemeier and Delorme procedures, which are tailored to each person's circumstances. Every patient is assessed individually — your age, fitness, symptoms, and goals all shape the recommendation.

If a prolapse comes out and you cannot push it back in — particularly if it is painful, turning dark, or you feel sick — this is an emergency and you should go to hospital immediately. For a prolapse that comes and goes, causes discomfort, is affecting your bowel control, or is having a significant effect on your quality of life and confidence, please seek a specialist assessment. This condition is very treatable — you do not need to simply live with it.

Your GP will send a referral and most patients are seen within one to two weeks. At the consultation, Mr Nguyen will take a careful history, examine you, and — where helpful — arrange a defecating proctogram or other imaging to understand exactly what is happening with the pelvic floor. Anorectal physiology may also be useful where bowel control is affected. Together these build a clear picture before any treatment decision is made.

For most patients, the recommended treatment is robotic-assisted ventral mesh rectopexy — a keyhole operation that fixes the prolapse from above with excellent results and a comfortable recovery. For frail patients or those for whom abdominal surgery carries too much risk, a perineal approach such as the Altemeier or Delorme procedure is offered instead. Surgery is performed at Warringal Private Hospital or Epworth Eastern, and a follow-up appointment is arranged to confirm recovery is going well and to discuss any improvement in bowel control.

Mr Ba Nguyen consults at his rooms in Heidelberg and operates at Warringal Private Hospital, Heidelberg, and Epworth Eastern, Box Hill. A GP or specialist referral is required.