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." It can be quite embarrassing and often has a significant, negative impact on a patient's quality of life, including the development of fecal incontinence. This condition affects mostly adults, and women over 50 years of age are six times as likely as men to develop rectal prolapse. Although an operation is not always needed, the definitive treatment of rectal prolapse requires surgery.

Why does rectal prolapse occur?

While a number of factors have been shown to be associated with rectal prolapse, there is no clear cut "cause." Chronic constipation (infrequent stools or severe straining) is present in 30% to 67% of patients, while an additional 15% experience diarrhea. Some have assumed that the development of rectal prolapse is a consequence of multiple vaginal deliveries, however, up to 35% of patients with rectal prolapse have never had children, and it can occur in men.

Is rectal prolapse the same as hemorrhoids?

Some of the symptoms may be the same: bleeding and/or tissue that protrudes from the rectum. Rectal prolapse, however, involves an entire segment of the bowel located higher up within the body, while hemorrhoids involve only the inner layer near the anal opening.

How is rectal prolapse diagnosed?

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 anus and rectum as they relate to having a bowel movement.

Treatment

Although constipation and straining may contribute to the development of rectal prolapse, simply correcting these problems may not improve the prolapse once it has developed. There are many different ways to surgically correct rectal prolapse. Abdominal or rectal surgery may be suggested. An abdominal repair may be approached via an open approach, laparoscopically, or even robotically in selected patients. The decision to recommend an abdominal or rectal surgery takes into account many factors, including age, physical condition, extent of prolapse, and the results of various tests. Options include removing part of the rectum or pulling the rectum back up and anchoring it. Occasionally mesh may be used.

How successful is treatment?

A great majority of patients are completely relieved of symptoms, or are significantly helped, by the appropriate procedure. Success depends on many factors, including the status of a patient's anal sphincter muscle before surgery, whether the prolapse is internal or external, and the overall condition of the patient. If the anal sphincter muscles have been weakened, either because of the rectal prolapse or for some other reason, they have the potential to regain strength after the rectal prolapse has been corrected. It may take up to a year to determine the ultimate impact of the surgery on bowel function. Chronic constipation and straining after surgical correction should be avoided.

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