Rectal Prolapse

Rectal Prolapse

Rectal Prolapse is a condition in which the rectum begins to push through the anus. The rectum is the last part of the large intestine, and the anus is the opening through which waste leaves the body.

This condition affects around 2.5 people out of 100,000. This condition is around six times more likely to occur in women who are over the age of fifty, as compared to men. The condition can range from mild to severe. Although mild cases can be treated without surgery, some of the severe cases require surgical intervention.

Although the rectum pushing and dropping down your anus might seem quite worrisome to many people, this condition is generally not a medical emergency. However, if you have this condition for too long, it might eventually get worse. The condition might also lead to embarrassment and affect a person’s quality of life.

While having a bowel movement, if you feel that something is not right, you should not ignore it. You should consider seeing a doctor as soon as you can, and receive a proper diagnosis.

Symptoms

The symptoms of this condition generally occur slowly. The first symptom is generally a feeling of a bulge in the anus. It might feel as though are sitting on a ball. With the help of a mirror, you might be able to see a reddish bulge peeking through or extending out of the anus.

During some bowel movements, a small part of the rectum will emerge, but it should retreat on its own or may be easily pushed back into its place.

Walking, sitting, exercise and any such normal physical activity also cause part of the rectum to push through the anus. If this condition worsens, there may be bleeding from the inner lining of the rectum. However, in cases of partial or complete prolapse, you might even have trouble controlling bowel movements.

Around half of the people with this condition also experience constipation.

Types

Rectal prolapse is of three types. The type is identified by the movement of the rectum:

  • Internal prolapse- In this type, the rectum starts to drop, but it hasn’t pushed through the anus yet.

 

  • Partial prolapse- In this type, only part of the rectum has moved through the anus.

 

  • Complete prolapse- In this type, the entire rectum extends out through one’s anus.

Causes & risk factors

A variety of things can lead to this condition, and some of them include the following:

  • Having a long-term history of diarrhea or constipation
  • Having a long-term history of having to strain during a bowel movement
  • Nerve damage that affects the ability of your muscles to tighten and loosen, which can result from pregnancy, vaginal childbirth complications, anal sphincter paralysis, or even an injury to your spine or back
  • Old age, which might weaken muscles as well as ligaments in the rectal area
  • Previous injury to the anal or hip area
  • Neurological problems, which can include spinal cord disease or spinal cord transection

 

Generally, women develop rectal prolapse more than men, especially women older than the age of 50. In general, older people who have had a history of constipation or problems with their pelvic floor are known to have a higher chance of having the problem.

Some of the health conditions which can lead to rectal prolapse include the following:

  • Chronic constipation
  • Always having to strain for a bowel movement
  • Congenital bowel disorders such as Hirschsprung’s disease or neuronal intestinal dysplasia
  • Lower back injury or disc disease
  • Chronic obstructive pulmonary disorder
  • Benign prostatic hypertrophy
  • Any injury or problems with ligaments keeping your rectum attached to the intestinal wall
  • Muscle weakness in your anus or pelvic floor
  • Having a close relative also having rectal prolapse
  • Certain parasitic infections

Diagnosis

Your doctor is very likely going to perform a rectal exam at first. However, if you are hesitant about this, he/she might ask you to sit on a toilet and try to have a bowel movement. This should help your doctor to see the prolapse.

However, some more advanced tests might also be required, especially if you are having other related conditions. Some of them include the following:

Anal electromyography (EMG)

This test helps to check if nerve damage is leading to your anal sphincter problems.

Anal manometry

In this test, a thin tube is inserted into your rectum to test the strength of the muscle.

Colonoscopy

A long tube with a tiny camera is inserted into your rectum. It can show the inside of your intestines and also look for any problems that might be causing the prolapse.

Anal ultrasound

During an anal ultrasound, a probe inserted into your anus and rectum is used to examine the muscles as well as the tissues.

Proctosigmoidoscopy

This test also uses a long tube which is attached to a camera on the end. This tube is inserted deep into the intestines to check for inflammation, scarring, or tumors.

MRI

This imaging scan examines all the organs in the pelvic area.

Pudendal nerve terminal motor latency test

It checks your pudendal nerves, which is used to control bowel movements.

Proctography

X-ray videos of your rectum during a bowel movement can also show how well it holds and releases the stool.

Treatment

The most common treatment for rectal prolapse is surgery for putting the rectum back in its place. The kind of surgery your doctor is going to recommend will depend on factors like your overall health, age, and how serious your condition is. The two most common types of surgery include the following:

Abdominal surgery

This type of surgery can be performed either with a large incision or using the laparoscopic method, which makes the use of small cuts along with a camera attached to an instrument so that the surgeon is able to see what needs to be done and if there are any additional issues that require fixing.

Perineal surgery

Also known as rectal repair, this approach can be used if you are older or if you have any other medical problems. This type of surgery may involve the inner lining of the rectum or the portion of the rectum which extends out of the anus.
If your rectal prolapse is minor and it is diagnosed early, your doctor might have you treat it with the help of stool softeners. These make it easier to go to the bathroom since you will be able to push the tissue of the rectum back up the anus using your arm. But, typically, surgery is eventually required to fix this condition.

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