As the name suggest, it is a situation when the rectum, which is located above the anus and is the lower end of the colon, loses its elasticity and collapses. Sometimes the rectum can even protrude outside the body. The tissues of the rectum may come outside only during the bowel movements or while sneezing or it may remain outside at all times. It is most common among the elderly, especially women and also children below 6 years of age. One of the main causes for the prolapsed rectum is the weakening of the anal sphincter.
This group of muscles is fragile and cannot support the canal alone; hence weakness of these muscles causes the rectum to move downwards due to gravity. There are many causes for the anal sphincter to be weakened, like advancing age, pregnancy, stresses of childbirth, prolonged straining during constipation, diarrhea, cystic fibrosis, anal intercourse, and spinal cord trans-section.
There are three different varieties of rectal prolapse. Internal intussception is the situation in which the rectum collapses inside the body and it does not protrude outside. It falls against another internal organ sometimes twisting itself, which causes extreme pain. Another sort of prolapse is when only the mucosa, which is a thin membrane, collapses and protrudes. It may lead to a tearing of the mucosa which may cause bleeding. The most disturbing prolapse is when the entire rectum can be seen through the anus.
Rectal Prolapse Symptoms
The obvious symptom is the protruding tissue through the anus. In case of internal intussception rectal prolapse, the patient may feel bloated, internal discomfort, difficulty and pain during bowel movements, constipation, fecal inconsistency or loss of the urge to defecate. In some cases bleeding and mucus discharge may also be noticed from the damaged tissues. Malnutrition, pinworm and whipworm infection are also associated with rectal prolapse.
Rectal Prolapse Diagnosis and Treatment
Anorectal examination and complete medical history are the first step of diagnosis. The patient may be asked to exert pressure as though having a bowel movement. In case of internal prolapse an x-ray called videodefecogram may be taken. Under this method the x-rays are taken when the patient is performing the bowel movement. Anorectal manometry test also be done, if required, by the doctor to diagnose the problem.
In minor cases the prolapse can be treated at home. The patient is taught to push the tissue into its position through the anus, using a warm wet cloth while sitting in the knee-chest position. This position helps the patient to apply pressure gently and gravity also helps to keep the tissue in its position. If the prolapse is caused due to pregnancy or child birth, then either the problem cures by itself or through this self help method. Sometimes stool softener or other medication or support mechanisms may also be used. But most people may require surgery. There are mainly two types of surgery that could be performed, depending on the nature of the problem, the age of the patient and the medical history.
Open surgery or laparotomy – this procedure is performed by cutting a hole through the abdomen to get full access to the walls and the muscles of the rectum and anus. The rectum is attached to the surrounding walls. The risk involved is higher as other organs or nerves may be damaged during the surgery. Though it takes a long time for the patient to heal, the risk of a repeat prolapse in significantly reduced. This procedure is very traumatic to the body so it cannot be performed on older patients or those who cannot stand general anesthesia. A keyhole surgery or laparoscopic surgery is also performed on similar line. Under this procedure a very small incision is made near the problem and a mesh is added, through surgical instruments, to protect the rectum from prolapsing again.
Anal surgery- this perineal procedure is performed at the anus, where the damaged section is removed and the structure is repaired and placed back into its position. This procedure is normally performed on aged patients. But chances of a reoccurrence are very high. The main risk after any type of surgery is bleeding and infection. Though, some patients may complain of constipation, inconsistency or another prolapse. However, rectal prolapse may be of different kind some may also include the pelvis hence the type of surgical procedure performed may vary.
Anterior resection, Marlex rectopexy, Suture rectopexy and Resection rectopexy are varied abdominal procedures that are followed for fixing a prolapse. Similarly, Anal encirclement, Delorme mucosal sleeve resection, Altemeier perineal rectosigmoidectomy, Surgery for mucosal prolapse and Perineal stapled prolapse are perineal procedures. The type of procedure to be performed on a patient is best decided by a doctor.