Rectal prolapse occurs as soon as the rectum (the lower finish of the large intestine) falls from its normal position within the pelvic area. In some instances of an extremely minor, at an early stage prolapse, therapy can begin at home with the usage of stool softeners. However, surgery will be vital to repair the prolapse.

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What is rectal prolapse?

Rectal prolapse occurs when the rectum (the last ar of the big intestine) drops from that normal position within the pelvic area and sticks out through the anus. (The word "prolapse" way a falling down or slipping the a body part from its usual position.)

The hatchet "rectal prolapse" can define three types of prolapse:

The whole rectum extends out of the anus.Only a portion of the rectal lining is driven through the anus.The rectum starts come drop down but does not extend out the anus (internal prolapse).

Rectal prolapse is common in older adult who have actually a long-term history of constipation or a weakness in the pelvic floor muscles. That is much more common in females than in men, and even more common in females over the period of 50 (postmenopausal women), however occurs in younger civilization too. Rectal prolapse can also occur in infants – which could be a authorize of cystic fibrosis – and in older children.

Is rectal prolapse just an additional name for hemorrhoids?

No. Rectal prolapse results from a slippage the the attachments that the last part of the large intestine. Hemorrhoids are swollen blood vessels that develop in the anus and lower rectum. Hemorrhoids can produce anal itching and also pain, discomfort and also bright red blood ~ above toilet tissue. Early on rectal prolapse deserve to look like internal hemorrhoids that have slipped the end of the anus (i.e., prolapsed), make it difficult to tell these two conditions apart.

Symptoms and Causes

What causes rectal prolapse?

Rectal prolapse can happen as a result of countless conditions, including:

Long-term background of straining throughout bowel movementsOlder age: Muscles and ligaments in the rectum and anus normally weaken with age. Other nearby structures in the pelvis area likewise loosen through age, which adds come the general weakness in the area of the body.Weakening that the anal sphincter: This is the specific muscle that controls the relax of stool from the rectum.Earlier injury to the anal or pelvic areasDamage to nerves: If the nerves that regulate the ability of the rectum and also anus muscles to contract (shrink) are damaged, rectal prolapse can result. Nerve damage can be caused by pregnancy, complicated vaginal childbirth, anal sphincter paralysis, spinal injury, earlier injury/back surgical procedure and/or other surgeries the the pelvic area.

What room the symptom of rectal prolapse?

The symptom of rectal prolapse incorporate the emotion of a bulge or the appearance of reddish-colored mass the extends outside the anus. At first, this have the right to occur during or after bowel movements and also is a temporary condition. However, gradually – due to the fact that of an plain amount that standing and also walking – the finish of the rectum may also extend the end of the anal canal spontaneously, and also may should be pushed ago up into the anus by hand.

Other symptoms of rectal prolapse include pain in the anus and also rectum and bleeding indigenous the inside lining that the rectum. This are seldom life-threatening symptoms.

Fecal incontinence is another symptom. Fecal incontinence refers to leakage that mucus, blood or stool indigenous the anus. This occurs as a result of the rectum stretching the anal muscle. Symptoms readjust as the rectal prolapse itself progresses.

Diagnosis and Tests

How is rectal prolapse diagnosed?

First, your physician will take your medical background and will carry out a rectal exam. You may be asked come "strain" while sitting on a commode come mimic an really bowel movement. Being able to watch the prolapse helps your physician confirm the diagnosis and also plan treatment.

Other conditions, such together urinary incontinence, bladder prolapse and also vaginal/uterine prolapse, can be present along with rectal prolapse. Due to the fact that of the range of potential problems, urologists, urogynecologists and other specialists regularly team with each other to re-publishing evaluations and also make joint therapy decisions. In this way, surgeries to fix any mix of these troubles can be done at the very same time.

Doctors deserve to use numerous tests to diagnose rectal prolapse and other pelvic floor problems, and to help determine the best treatment because that you. Tests offered to evaluate and make treatment decisions include:

Anal electrostclairdrake.netography (EMG): This test determines if nerve damages is the reason why the anal sphincters room not functioning properly. It also examines the coordination between the rectum and also anal muscles.Anal manometry: This test researches the strength of the anal sphincter muscles. A short, thin tube, put up into the anus and also rectum, is offered to measure up the sphincter tightness.Anal ultrasound: This check helps evaluate the shape and structure the the anal sphincter muscles and also surrounding tissue. In this test, a small probe is placed up right into the anus and also rectum to take photos of the sphincters.Pudendal nerve terminal engine latency test: This test measures the duty of the pudendal nerves, i beg your pardon are involved in bowel control.Proctography (also called defecography): This test is excellent in the radiology department. In this test, one X-ray video clip is taken that shows exactly how well the rectum is functioning. The video clip shows exactly how much stool the rectum deserve to hold, how well the rectum holds the stool, and how well the rectum release the stool.Proctosigmoidoscopy: This test permits the lining the the lower portion of the colon to be viewed, spring for any abnormalities such together inflammation, tumor or scar tissue. To execute this test, a versatile tube with a camera attached come the finish is inserted into the rectum as much as the sigmoid colon.

Management and Treatment

How is rectal prolapse treated?

In some instances of really minor, early on prolapse, treatment can start at house with the usage of stool softeners and by pushing the collapse tissue back up into the anus by hand. However, surgery is usually essential to repair the prolapse.

There are several surgical approaches. The surgeon’s selection depends top top patient’s age, other existing health and wellness problems, the level of the prolapse, results of the exam and other tests and also the surgeon’s preference and experience with details techniques.

Abdominal and rectal (also dubbed perineal) surgery are the two most typical approaches to rectal prolapse repair.

Abdominal repair approaches

Abdominal procedure describes making an scratch in the abdominal muscles to view and also operate in the abdominal cavity. It is normally performed under basic anesthesia and is the strategy most often used in healthy and balanced adults.

The two many common species of abdominal muscle repair space rectopexy (fixation of the rectum) and also resection (removal that a segment of intestine) complied with by rectopexy. Resection is wanted for patient who have actually severe constipation. Rectopexy can additionally be performed laparoscopically through tiny keyhole incisions, or robotically, making restore much simpler for patients.

Rectal (perineal) fix approaches

Rectal procedures are regularly used in older patients and in patients that have more medical problems. Spinal anesthesia or one epidural (anesthesia that blocks pains in a certain part of the body) may be used rather of general anesthesia in these patients. The two most common rectal ideologies are the Altemeier and also Delorme procedures:

Altemeier procedure: In this procedure -- likewise called a perineal -- the part of the rectum expanding out the the anus is reduced off (amputated) and the 2 ends are sewn back together. The remaining structures that help support the rectum space stitched earlier together in an attempt to provide much better support.Delorme procedure: In this procedure, just the within lining that the please rectum is removed. The outer layer is climate folded and stitched and also the cut edges that the within lining space stitched together so the rectum is currently inside the anal canal.

What room the risks/complications the may take place after rectal prolapse surgery?

As with any kind of surgery, anesthesia complications, bleeding and also infection are always risks. Other risks and complications indigenous surgeries to fix rectal prolapse include:

Lack of healing wherein the 2 ends that bowel reconnect. This can take place in a surgical treatment in i m sorry a segment of the bowel is removed and also the 2 ends that the remaining bowel are reconnected.Urinary retention (inability to pass urine)Return of the rectal prolapseWorsening or breakthrough fecal incontinenceWorsening or breakthrough of constipation

After surgery, constipation and also straining need to be avoided. Fiber, fluids, stool softeners and mild laxatives can be used.

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Outlook / Prognosis

How effective is rectal prolapse surgery?

Success can vary depending on the problem of sustaining tissues and the age and health the the patient. Abdominal muscle procedures are associated with a lower chance the the prolapse coming back, contrasted with perineal procedures. However, in many patients, surgery fixes the prolapse.

How long is recovery from rectal prolapse surgery?

The average length of hospital continue to be is 2 to 3 days, however this varies depending upon a patient’s other health conditions. Finish recovery have the right to usually be meant in a month; however, patients have to avoid straining and heavy lifting because that at least 6 months. In fact, the best chance for preventing prolapse from return is to make a lifetime effort to protect against straining and also any tasks that increase abdominal muscle pressure.