What is Rectal Prolapse?
Rectal Prolapse is the protrusion of either the rectal mucosa or the entire wall of the rectum. Partial prolapse involves only the mucosa and usually only protrudes by a few centimeters. Complete prolapse involves all layers of the rectal wall.
- Prolapses of the rectum occur either with bowel movements or independently. In the elderly, rectal prolapse initially only occurs with defecation and then retracts spontaneously.
- More advanced rectal prolapses may occur when standing and so greatly interfere with the patient’s quality of life.
Causes of Rectal Prolapse
The exact Cause of Rectal Prolapse is unclear. Possible causes may include any of the following
- Defect in the pelvic floor through which hernia may slip down
- Loose muscles of the anal sphincter
- An abnormally long colon
- Downward movement of the abdominal cavity between the rectum and uterus
- Prolapse of the small intestine
- Chronic coughing and sneezing
- A prolapse can be partial or complete:
- With a partial prolapse, the inner lining of the rectum bulges partly from the anus.
- With a complete prolapse, the entire rectum bulges through the anus.
- Rectal prolapse occurs most often in children under age 6. Health problems that may lead to prolapse include:
- Cystic fibrosis
- Intestinal worm infections
- Long-term diarrhea
- Other health problems present at birth
- In adults, it is usually found with constipation, or with a muscle or nerve problem in the pelvic or genital area.
Symptoms of Rectal Prolapse
A person with a prolapsed rectum may feel tissue protruding from the anus and experience the following symptoms:
- Pain during bowel movements
- Mucus or blood discharge from the protruding tissue
- Fecal incontinence (inability to control bowel movements)
- Loss of urge to defecate (mostly with larger prolapses)
- Awareness of something protruding upon wiping
Diagnosis of Rectal Prolapse
- Barium enema and/or colonoscopy
- Anal physiology tests
- Rigid proctosigmoidoscopy
Other investigations to assess underlying conditions include
- Stool microscopy
- Cultures for gastrointestinal infection
- Sweat test for cystic fibrosis.
Treatment of Rectal Prolapse
Early prolapse, treatment can begin at home with the use of stool softeners and by pushing the fallen tissue back up into the anus by hand.
However, surgery is usually necessary to repair the prolapse. Abdominal and rectal (also called perineal) surgery are the two most common approaches to rectal prolapse repair.
- Abdominal repair approaches
Abdominal procedure refers to making an incision in the abdominal muscles to view and operate in the abdominal cavity. It is usually performed under general anesthesia and is the approach most often used in healthy adults. The two most common types of abdominal repair are rectopexy (fixation [reattachment] of the rectum) and resection (removal of a segment of intestine) followed by rectopexy. Resection is preferred for patients with severe constipation. Rectopexy can also be performed laparoscopically through small key-hole incisions or robotically.
- Rectal (perineal) repair approaches
Rectal procedures are often used in older patients and in patients with more medical problem. Spinal anesthesia or an epidural may be used instead of general anesthesia in these patients.
By : Natural Health News