Rectal hernia

A rectal hernia is a colloquial term for a condition in which there is a protrusion of tissues within the anal canal or its immediate vicinity. In medical terminology, it most commonly corresponds to rectal prolapse (prolapsus recti), which is the protrusion of the rectal wall through the anus, and less commonly to perineal hernias or pelvic floor disorders. This condition occurs mainly in older individuals, more frequently in women, and is associated with the weakening of the pelvic support structures. The problem is not only anatomical but also functional—it affects bowel control, quality of life, and the hygiene of the anal region.

Rectal hernia – what it looks like

The clinical picture depends on the degree of advancement of the changes and the type of pathology.

The most common observations include:

Visible protrusion in the anal area, appearing during straining.
Red, moist tissue mass protruding from the anal canal.
In the early stages – spontaneous retraction of the change after defecation.
In advanced stages – necessity for manual reduction of the rectum.
In severe cases – constant prolapse of tissues.

The prolapse may be characterized as:

Partial (mucosal) – involving only the mucous membrane.
Total – involving all layers of the rectal wall.

Differential diagnosis includes other conditions of the anal area:

hemorrhoids,
anal fissure,
anal fistulas,
rectal tumors,
perineal hernias.

Proctological examination, including per rectum assessment and anoscopy, allows for proper diagnosis. In uncertain cases, defecography, transrectal ultrasound, or pelvic floor magnetic resonance imaging may be used.

Rectal hernia – symptoms

The symptoms are local and functional in nature and may gradually increase.

Most common symptoms:

Sensation of a foreign body in the anus.
Visible protrusion of tissues during defecation.
Incontinence of gas or stool.
Difficulty maintaining hygiene.
Itching and skin irritation.
Mucous discharge.
Sensation of incomplete evacuation.

As the disease progresses, it leads to:

weakening of the anal sphincters,
defecation control disorders,
chronic inflammatory conditions of the skin around the anus,
ulcerations of the mucous membrane.

Factors contributing to the development of rectal prolapse:

chronic constipation,
prolonged straining,
natural childbirth,
pelvic surgeries,
obesity,
chronic cough,
neurological disorders,
weakening of the pelvic floor muscles.

Hernia of the anus – does it hurt

Pain is not always the dominant symptom. The nature of the discomfort depends on the degree of prolapse and complications.

Possible scenarios:

In the early stage – often no pain, discomfort is predominant.
In advanced stages – feeling of pulling or pressure.
In case of swelling or thrombosis – pain may be severe.
Incarceration (inability to reduce) – increasing, sharp pain requiring urgent surgical intervention.

Pain can also result from secondary complications:

mucosal ulcers,
infections,
skin irritation,
coexisting hemorrhoids or anal fissure.

It should be emphasized that the absence of severe pain does not exclude advanced pathology. Rectal prolapse is a progressive condition and if untreated, leads to permanent functional disorders.

Hernia of the anus – treatment

Treatment depends on the degree of advancement and the overall condition of the patient.

Conservative Treatment

Used in the early stages:

regulation of bowel movements,
high-fiber diet,
adequate hydration,
stool softeners,
pelvic floor muscle exercises (so-called Kegel exercises),
biofeedback.

Conservative treatment does not eliminate the anatomical cause but can slow down progression.

Surgical Treatment

It is the method of choice in cases of complete prolapse.

Most commonly performed procedures:

Abdominal rectopexy (traditional or laparoscopic) – attaching the rectum to the sacrum.
Resection of excess rectum.
Transanal procedures (e.g., Delorme's, Altemeier's methods).

The choice of technique depends on:

the age of the patient,
comorbidities,
degree of prolapse,
anal sphincter function.

The goals of treatment are:

restoration of normal anatomy,
improvement of sphincter control,
reduction of recurrence risk.

Currently, minimally invasive techniques are preferred, which shorten hospitalization and reduce the risk of complications.

Summary

Rectal prolapse, most commonly associated with rectal prolapse, is a condition resulting from the weakening of the pelvic floor structures. It manifests as the protrusion of tissues through the anus, disturbances in defecation control, and discomfort. Pain is not always present; however, the disease is progressive. Early diagnosis and appropriate surgical treatment significantly improve prognosis and the patient's quality of life.