All You Need To Know About Rectal Prolapse: The What, Why & How To Treat

Doctor puts on medical gloves for examination of the patient's rectum for rectal prolapse
Contributed by: Priyaish Srivastava

 

What is a prolapse of the rectum?

Prolapse is a clinical condition during which a part of the body organ extends enough to bulge out from an opening like that of an anus. Rectal prolapse occurs when the end of the large intestine (also known as the rectum) flips inside out and protrudes through the anus canal, which is where feces leave from.

The prolapse of the rectum or medically known as rectal prolapse is a disorder in which the rectum protrudes outside of the body and needs surgery for treatment. It generally affects adult people and mostly women who are above the age of 50 (post-menopausal women).

It can also affect newborns, who are more vulnerable to typical abdominal problems such as persistent constipation, chronic diarrhea, or straining while going to the toilet. Prolapse of the rectum in a newborn can be caused by cystic fibrosis, a disease in which some organs fail to function properly, resulting in several health problems.

Rectal prolapse is very common in adults and the elderly and the condition might appear to be scary and embarrassing, Yet, the patient should not be afraid to discuss his or her concerns with the doctor as soon as possible. Ignoring the problem can lead to significant health issues.

 

Types of rectal prolapse

The rectal prolapse can cause any three of the following conditions:

 

Mucosal prolapse

Mucosal prolapse (also known as partial prolapse) is a disorder in which a portion of the rectal lining (known as mucosa) protrudes from the anus. Although the disease is unlikely to be harmful, it may need surgery to fix mucosal prolapse.

 

Internal prolapse

Internal prolapse, also known as incomplete prolapse, occurs when the rectum protrudes but not far enough to stick out of the anus. Internal prolapse can cause pain and discomfort in the bottom region of the abdomen. 

 

External prolapse

External prolapse occurs when the whole rectum protrudes and sticks out of the anus, which can be felt with regular bowel movements. Also known as total or full-thickness prolapse, it is the most frequent kind of prolapse and produces a lot of pain.

 

Symptoms of a rectal prolapse

Rectal prolapse develops symptoms at a slow pace. The most frequent and initial symptom of rectal prolapse is a bulge protruding out of the anus hole during normal bowel movements. However, there are a number of additional signs and symptoms that signal the onset of rectal prolapse, including:

 

  • Seeing red color bulge near the anal sphincter through a mirror
  • Pain and discomfort in the lower abdomen 
  • Appearance and leakage of blood and mucus near the anal canal
  • Constipation and feeling that the stomach isn’t fully empty (tightness) after a bowel movement
  • Discomfort during physical movements

 

Rectal prolapse causes

Physical examination is the most common way to identify rectal prolapse. The doctor may ask the patient to defecate or do a mock bowel movement in order to check for prolapse. Depending on the severity of the disease, additional diagnostics may be necessary.

 

These diagnostics can be:

 

  • Anal electromyography (EMG): EMG is a method for identifying the health of the nerves. That is, the doctor examines whether the malfunctioning of the anal sphincters is caused by nerve issues.

 

  • Anal manometry: Anal manometry is a procedure in which a doctor inserts a thin, tiny tube into the anal sphincter muscles in order to measure their strength.

 

  • Anal ultrasound: An anal ultrasound involves inserting a tiny probe into the anus and rectum and capturing pictures of the sphincter to evaluate the form and structure of muscles and tissues.

 

  • Proctography: A proctography test (also known as defecography) is used to assess how well the rectum is working. This test uses an X-ray movie to see how well the rectum retains and discharges excrement.

 

  • Colonoscopy: Colonoscopy is a procedure that involves inserting a flexible tube with a small camera and light. The tube is guided from the rectum to the point where the large and small intestines meet. With the use of visual clues, this exam aids in determining the root of the problem.

 

Treatment for rectal prolapse

The treatment of rectal prolapse depends upon several factors like the patient’s age, medical history, length of the prolapse, existing health problems, and the result of the diagnosis.  

There are two main rectal prolapse surgery types:

 

  • Abdominal repair: The doctor provides general anesthesia to the patient and creates an incision in the abdominal muscles to operate in the abdominal cavity. This approach is usually preferred for healthy adults and can also be performed via laparoscopic surgery. Besides attending to the rectal prolapse, the surgeon can also fix any other issues in the vicinity of the prolapse.

 

  • Rectal repair: A rectal repair, also known as a perineal repair, is recommended when a patient is elderly or someone who has a pre-existing illness. Before beginning the procedure, the patient is given spinal anesthesia, which inhibits pain in a specific area of the body. The rectal repair can be accomplished in one of two ways:

 

    • Altemeier procedure: In this process, the outgrown portion of the rectum is amputated (cut off), and the two ends are stitched together.
    • Delorme procedure: The inner lining of the protruded rectum is removed during this surgery. The outer layer is folded and stitched, as are the cut edges of the inner lining. The explicit goal of Delorme surgery is to re-insert the rectum into the anus.

 

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