Rectal prolapse: symptoms, causes, treatment and how to prevent it

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Definition

What is rectal prolapse?

Rectal prolapse is a condition when the walls of the rectum prolapse until they stick out of the anus and are visible outside the body. Rectal prolapse may occur without symptoms, but depending on the nature of the prolapse, there may be mucus discharge (mucus out of the anus), rectal bleeding, some degree of fecal incontinence, and symptoms of obstructed bowel movements.

How common is rectal prolapse?

Rectal prolapse is generally more common in older women, although it can occur at any age and in both sexes. This condition is very rarely life threatening, but the symptoms can be debilitating if left untreated. Most cases of external prolapse can be treated successfully, often by surgical procedures. Internal prolapse has traditionally been more difficult to treat and surgery may not be suitable for many patients.

However, this can be overcome by reducing your risk factors. Talk to your doctor for more information.

Signs & symptoms

What are the signs and symptoms of rectal prolapse?

Rectal prolapse signs and symptoms include:

• a history of prominent clots
• a certain degree of urinary incontinence, which may only be in the form of mucus discharge
• constipation is also described as tenesmus (sensation of incomplete evacuation of stool)
• feeling of pressure
• rectal bleeding
• diarrhea and erratic bowel habits
• Initially, the clot can protrude out of the anal canal only during bowel movements and straining, and spontaneously return thereafter. Then, the clot should be pushed back after defecating. It can develop into a chronic, severe condition of prolapse, defined as spontaneous prolapse that is difficult to stay within, and occurs when walking, standing for long periods of time, coughing or sneezing (Valsalva maneuver). Chronic prolapsed rectal tissue can undergo pathological changes such as thickening, ulceration, and bleeding.

If the prolapse becomes trapped externally outside the anal sphincter, the prolapse can strangulate and there is a risk of perforation. This may require urgent surgical operation if the prolapse cannot be reduced manually. Applying granulated sugar to exposed rectal tissue can reduce edema (swelling) and relieve this condition.

There may be signs and symptoms not listed above. If you have concerns about certain symptoms, consult your doctor.

When should I see a doctor?

If you experience any of the signs or symptoms listed above, or have any questions, please consult your doctor. Everyone's body reacts differently. It is always best to discuss what is best for your situation with your doctor.

Cause

What causes rectal prolapse?

The exact cause is unknown, and has been much debated. There are several underlying disorders of the pelvic floor that affect several pelvic organs. Proximal, bilateral, pudendal neuropathy has been demonstrated in patients with rectal prolapse who have fecal incontinence. These results were not found in healthy subjects and could be the cause of atrophy associated with denervation of the external anal sphincter. Some authors argue that pudendal nerve damage is a cause of weakening of the pelvic floor and anal sphincter, and could be an underlying cause of the spectrum of pelvic floor disorders.

Risk factors

What increases my risk for rectal prolapse?

Many things can increase the chances of having rectal prolapse. Child risk factors include:

• Cystic fibrosis. A child who has rectal prolapse without an obvious cause may need to be tested for cystic fibrosis.
• never had surgery on the anus as a baby
• malnutrition
• deformities or physical development problems
• straining during bowel movements
• infection

Risk factors for adults include:

• straining during bowel movements due to constipation
• tissue damage caused by surgery or childbirth
• weakening of the pelvic floor muscles that occurs naturally with age

Medicines & Medicines

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is rectal prolapse diagnosed?

The doctor will diagnose by asking questions about your symptoms and past medical and surgical problems. He or she will also perform a physical exam, which involves examining the rectum for stretched tissue and to find out how strongly the anal aphincter can contract.

You may need tests to rule out other conditions. For example, you may need a sigmoidoscopy, colonoscopy, or barium enema to look for tumors, sores (ulcers), or abnormally narrow areas in the colon. Or a child may need a sweat test to check for cystic fibrosis if the prolapse has occurred more than once or the cause is unclear.

What are the treatments for rectal prolapse?

In the early stages, rectal prolapse can be treated with stool softeners, suppositories and other drugs. However, most people will eventually need surgery to repair rectal prolapse.

The type of surgery you will have depends on the extent of your rectal prolapse and other health problems. The surgeon will choose the right surgery for you. He or she may recommend the following procedure.

• Perineal protectomy

Options include the Altemeier procedure and the Delorme procedure. In both procedures, the surgeon will remove the rectal prolapse through an incision in the rectum that protrudes. Perineal protectomy can sometimes be performed using spinal anesthesia, which reduces the risk of complications and speeds recovery.

• Sigmoid resection and rectopexy

The surgeon will make an incision in the abdomen and remove the sigmoid intestine, the part of the large intestine closest to the rectum and anus. The rectopexy procedure places the rectum into the bony structures attached to the lower backbone and pelvis (sacrum). In most cases, it is possible to perform this operation with minimally invasive surgery, which results in smaller incisions and a shorter hospital stay than conventional surgery.

• Rectopexy

Sometimes the surgeon will perform a rectopexy alone, without removing any intestines. In this case, he can use robotic surgery.

In children, rectal prolapse can usually be treated with stool softeners or other medications. If surgery is required, the surgeon should have special experience in minimally invasive techniques.

Children with rectal prolapse should be screened for cystic fibrosis, as rectal prolapse may be a sign of the disease.

Home remedies

What are some lifestyle changes or home remedies that can be done to treat rectal prolapse?

To treat any underlying conditions that cause or maintain rectal prolapse, a number of possible factors must be addressed:

• Painful area of ​​the rectum — After prolapse, you can experience pain in the muscles around the rectum; levator ani muscle. If you feel that the muscles of the tailbone (the "sitting bone" which you can feel in the lower part of the buttocks when you sit on a bicycle or hard chair), move both sides of your buttocks and just below the sacrum (the flat, slightly rounded bony pads in base of the spine) —You feel the levator ani muscles. There are a number of techniques that can be used to reduce or relieve pain in this area.
• Straining to pass a bowel movement or having an inappropriate stool — the western way of sitting on the toilet prevents the rectum from stretching out and opening — makes us much more prone to constipation, hemorrhoids and fissures. Constipation can play a big role in rectal prolapse and ongoing disorders.
• Pelvic muscles that are weakened, stretched, or traumatized — If you apply gentle pressure to the muscles closest to the area where the rectum prolapse is when you have a bowel movement, you may be able to hold the rectum in and prevent it from passing along with the stool.
• Bodywork therapy — The anorectal canal is surrounded by muscles and ligaments, in which the pudendal nerve is located. After surgery, childbirth, or any type of trauma or sustained strain, you may be exposed to strains of muscles, tendons or ligaments in related tissues or organs. These strains and weakening of muscles and ligaments can cause rectal prolapse. Another thing that can greatly help you cure the underlying cause of your prolapse is bodywork therapy from a specially trained practitioner.

If you have any questions, consult your doctor to understand the best solution for you.