Rectal prolapse can occur due to a lifelong habit of straining during bowel movement, hereditary factors, stresses due to childbirth or as part of the aging process when pelvic and anal sphincter muscles weaken. It occurs in women more often than men and its symptoms can often mimic those of hemorrhoids.
Stool softeners or other treatments for constipation may help but will not reverse the prolapse once it has developed. With complete rectal prolapse, incontinence (uncontrolled leakage of stool) can occur and surgical treatment may become necessary.
Rectal prolapse is a condition in which the rectum (a portion of the colon) looses its internal support and protrudes from the anus. Rectal prolapse may be internal but in advanced stages, it can be seen or felt outside the body. When this occurs, it is referred to as a complete rectal prolapse.
There are three chief conditions which come under the title rectal prolapse : -
- Full-Thickness rectal prolapse describes the entire rectum protruding through the anus
- Mucosal prolapse describes only the rectal mucosa (not the entire wall) prolapsing
- Internal intussusception wherein the rectum collapses but does not exit the anus
The symptoms of rectal prolapse depend on the severity, but can include : -
- Pain and discomfort felt deep within the lower abdomen
- Blood and mucus from the anus
- The feeling of constipation, or that the rectum is never completely emptied after passing a motion
- Protrusion of the rectum through the anus
- The need to use huge quantities of toilet paper to clean up following a bowel motion
- Leakage of liquefied faeces, particularly following a bowel motion
- Faecal incontinence, or reduced ability to control the bowels.
A physician can often diagnose this condition with a careful history and a complete anorectal examination. To demonstrate the prolapse, patients may be asked to sit on a commode and "strain" as if having a bowel movement.
Occasionally, a rectal prolapse may be "hidden" or internal, making the diagnosis more difficult. In this situation, an x-ray examination called a videodefecogram may be helpful. This examination, which takes x-ray pictures while the patient is having a bowel movement, can also assist the physician in determining whether surgery may be beneficial and which operation may be appropriate. Anorectal manometry may also be used to evaluate the function of the muscles around the rectum as they relate to having a bowel movement.
Treatment depends on the age of the patient and the severity of the prolapse, but could include: Diet and lifestyle changes to treat chronic constipation: for example, more fruit, vegetables and wholegrain foods, increased fluid intake and regular exercise. This option is often all that's needed to successfully treat rectal prolapse in young children. In cases of mucosal prolapse, the structures are secured in place with surgical rubber bands.
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