Rectal prolapse is a condition where the rectal lining or the entire wall of the rectum protrudes through the anus. This occurs due to the weakening of supporting pelvic floor muscles and ligaments, often triggered by chronic straining or childbirth. Manual reduction, or gently pushing the tissue back into place, provides immediate relief but is strictly a temporary measure. A person should only attempt this if medical attention is delayed or if a healthcare professional has previously instructed them on the technique. The presence of a prolapse demands an immediate medical evaluation by a specialist to address the underlying cause and prevent recurrence.
Identifying Prolapse and Absolute Safety Limits
A rectal prolapse typically appears as a reddish, fleshy mass extending from the anus, which can be confused with a severe prolapsed internal hemorrhoid. A distinguishing feature lies in the appearance of mucosal folds on the protruding tissue. Rectal prolapse involves the full circumference of the rectal wall, presenting with distinct concentric, circular folds, similar to a telescope turned inside out. In contrast, a prolapsed hemorrhoid usually displays radial folds, radiating outward from the center, and often appears as separate, grape-like clusters.
A person must immediately stop any attempt at home reduction and seek emergency medical care if the protruding tissue shows signs of compromised blood flow. The presence of severe, disproportionate pain, or any change in the tissue’s color to a dark purple, blue, or black hue indicates strangulation or incarceration. This loss of blood supply is a medical emergency that can lead to tissue death (necrosis) and requires immediate surgical intervention. Excessive bleeding that does not quickly stop or the inability to pass gas or stool are also absolute contraindications for attempting self-reduction.
Preparing for Manual Reduction
Before touching the prolapsed tissue, preparing the area and gathering necessary supplies is important to prevent infection and facilitate reduction. Begin by thoroughly washing hands with soap and water, and wear disposable medical gloves if available to minimize the risk of bacterial transfer to the exposed rectal mucosa. The exposed tissue must be protected from drying out or sustaining injury.
A generous amount of water-soluble lubricant (such as petroleum jelly or a surgical gel) should be applied to the prolapse and the anal opening to reduce friction. Finding a position that relaxes the pelvic floor and anal sphincter muscles is helpful. Lying on one’s side with knees drawn up toward the chest, or assuming the fetal position, promotes this muscular relaxation.
If the prolapse is significantly swollen (edematous), a temporary measure to shrink the tissue is the application of granulated white sugar. Sugar acts as a hypertonic osmotic agent, drawing excess fluid out of the swollen tissue through osmosis. Sprinkling a thin layer of table sugar over the entire surface of the prolapse and allowing it to sit for 10 to 15 minutes can reduce the edema enough to make manual reduction possible.
Step-by-Step Manual Reduction Technique
Once the area is prepared and lubricated, the reduction should be attempted with utmost gentleness and patience. The goal is to apply steady, firm pressure to the end of the prolapse to guide it back into the anal canal. Place the pads of the fingers or the thumb flat against the distal-most point of the prolapse (the part furthest from the body).
The pressure should be directed upward and slightly backward, following the natural curve of the anal canal. Maintain continuous, gentle pressure, avoiding any sudden, jabbing, or forceful movements that could cause trauma to the rectal wall. It is often easiest to start by reducing the edges of the prolapse first, pushing the entire mass into a cone shape as it inverts.
Continue the steady pressure until the entire mass slips back through the sphincter muscle and into the rectal vault. If the tissue is not easily reduced within a few minutes of gentle effort, or if the individual experiences a sharp increase in pain, the attempt should be stopped immediately. Prolonged or forceful attempts increase the risk of tissue damage and should signal the need for professional medical intervention.
Post-Reduction Care and Medical Follow-Up
Immediately after successful reduction, remain in a relaxed position for a short period to allow the anal sphincter to re-establish its tone around the reduced rectum. Monitor for any signs of recurrence, incomplete emptying, or the persistent urge to defecate, which indicates the tissue has not stayed in place. If the prolapse re-emerges quickly or if a person develops abdominal pain, they should seek medical attention.
Home reduction is not a cure, and recurrence is highly probable without addressing underlying causes, such as chronic straining associated with constipation or diarrhea. Long-term management begins with lifestyle adjustments aimed at achieving soft, easily passed stools, involving a high-fiber diet and sufficient water intake. Stool softeners or bulking agents may be recommended by a physician to prevent any future need to strain.
Schedule an appointment with a colorectal specialist or surgeon promptly to determine the permanent treatment plan. Treatment options can range from pelvic floor physical therapy and biofeedback to various surgical procedures like rectopexy, which secures the rectum back into its normal anatomical position. The specialist will assess the severity of the prolapse and recommend the most suitable intervention to prevent the condition from returning.