By What is Rectal Prolapse?
Rectal prolapse is a condition in which the rectum (the last part of the large intestine before it exits the anus) loses its normal attachments inside the body, allowing it to telescope out through the anus, thereby turning it “inside out.” While this may be uncomfortable, it rarely results in an emergent medical.
Causes of Rectal Prolapse
There are several factors that can contribute to the development of rectal prolapse:
- Aging: As we get older, the muscles and connective tissues that support the rectum can weaken, leading to prolapse.
- Pregnancy and childbirth: The strain of pregnancy and the trauma of childbirth, especially multiple vaginal deliveries, can damage the pelvic floor muscles and lead to rectal prolapse.
- Chronic constipation or diarrhea: Straining during bowel movements, whether from constipation or diarrhea, can put excessive pressure on the rectal muscles and cause them to weaken over time.
- Previous pelvic or rectal surgery: Operations in the pelvic region, such as hemorrhoid removal or prostate surgery, can disrupt the normal anatomy and contribute to rectal prolapse.
- Neurological conditions: Diseases that affect the nerves, such as diabetes, stroke, or spinal cord injuries, can impair the function of the muscles that support the rectum.
- Chronic coughing or straining: Repeated strain on the pelvic floor, such as from a chronic cough or heavy lifting, can weaken the muscles over time.
- Congenital abnormalities: Some people are born with inherent weaknesses in the pelvic floor or rectal support structures, predisposing them to prolapse.
Symptoms of Rectal Prolapse
The primary symptom of rectal prolapse is the sensation of a lump or mass protruding from the anus. Other common symptoms include:
- A feeling of fullness or pressure in the rectum, even after a bowel movement
- Mucus or blood discharge from the anus
- Fecal incontinence, or the inability to control bowel movements
- Pain, discomfort, or irritation in the anal region
The severity of symptoms can vary depending on the degree of prolapse. In some cases, the prolapsed rectum may only protrude slightly during bowel movements and then retract back inside. In more advanced cases, the rectum may remain constantly protruded outside the anus.
Diagnosis of Rectal Prolapse
Rectal prolapse is typically diagnosed through a physical examination. Your doctor will visually inspect the anus and rectum, and may also perform a digital rectal exam, inserting a gloved, lubricated finger into the rectum to feel for any abnormalities.
Additional diagnostic tests may include:
- Anorectal manometry: This test measures the pressure and function of the anal sphincter muscles.
- Defecography: This X-ray study evaluates the mechanics of bowel movements and can help identify the extent of prolapse.
- Endoanal ultrasound: This imaging test provides a detailed view of the anal sphincter muscles and surrounding structures.
- Colonoscopy: This procedure allows the doctor to visually inspect the entire colon and rule out other potential causes of rectal prolapse.
Treatment of Rectal Prolapse
The treatment for rectal prolapse depends on the severity of the condition and the underlying cause. In some cases, conservative, non-surgical treatments may be effective, while more advanced cases may require surgical intervention.
Non-Surgical Treatments
For mild or recent-onset rectal prolapse, the first line of treatment may be non-surgical approaches, such as:
- Manual reduction: If the prolapsed rectum is still relatively new and not severely swollen, your doctor may be able to gently push it back into place.
- Dietary changes: Increasing fiber intake and staying hydrated can help soften stool and reduce straining during bowel movements, which can help prevent or manage rectal prolapse.
- Pelvic floor exercises: Strengthening the muscles of the pelvic floor through Kegel exercises or physical therapy can help support the rectum and prevent further prolapse.
- Biofeedback therapy: This technique uses electronic sensors to help patients learn to better control and strengthen their pelvic floor muscles.
- Stool softeners: Over-the-counter or prescription medications that soften stool can reduce straining and help manage rectal prolapse.
Surgical Treatments
If non-surgical treatments are not effective, or if the prolapse is more severe, surgery may be recommended. The two most common surgical procedures for rectal prolapse are:
Abdominal Surgery
Abdominal surgery, also known as rectopexy, involves repairing and securing the rectum back into its proper position within the abdomen. This can be done through a traditional open incision or using a minimally invasive laparoscopic approach. The surgeon may use sutures, staples, or mesh to hold the rectum in place and prevent further prolapse.
Perineal Surgery
Perineal surgery, also called a perineal proctectomy or Delorme’s procedure, is typically recommended for older patients or those with other medical conditions that make abdominal surgery riskier. This approach involves removing the prolapsed portion of the rectum through an incision in the perineum, the area between the anus and the genitals.
The choice of surgical procedure will depend on factors such as the patient’s age, overall health, the severity of the prolapse, and the surgeon’s experience and preference. In some cases, a combination of abdominal and perineal techniques may be used.
Preventing Rectal Prolapse
While rectal prolapse cannot always be prevented, there are some steps you can take to reduce your risk:
- Treat constipation and diarrhea: Keeping your bowel movements regular and avoiding straining can help prevent weakening of the rectal muscles.
- Perform pelvic floor exercises: Strengthening the muscles of the pelvic floor through Kegel exercises can help support the rectum and prevent prolapse.
- Avoid heavy lifting and straining: Limit activities that put excessive pressure on the pelvic floor, such as lifting heavy objects or chronic coughing.
Conclusion
Rectal prolapse is a relatively common condition that can have a significant impact on a person’s quality of life. While it may not always be preventable, understanding the causes, symptoms, and treatment options can help individuals seek the appropriate care and manage this condition effectively. If you are experiencing any signs of rectal prolapse, it is important to consult with a healthcare provider for a proper diagnosis and personalized treatment plan.
