What is rectal prolapse. How does it develop. What are the risk factors. How is it diagnosed. What treatment options are available. How can it be prevented. What are the long-term implications.

Understanding Rectal Prolapse: A Comprehensive Overview

Rectal prolapse is a condition where part of the rectum, the final section of the large intestine, protrudes through the anus. Initially, this may occur only after bowel movements, with the prolapsed tissue retracting on its own. However, as the condition progresses, it can become more severe and potentially require surgical intervention.

The rectum plays a crucial role in the digestive system, serving as the storage area for feces before elimination. When the supporting structures weaken, it can lead to this uncomfortable and sometimes embarrassing condition.

Types of Rectal Prolapse

There are three main types of rectal prolapse:

• Partial prolapse (mucosal prolapse): Only the inner lining of the rectum protrudes
• Complete prolapse (full-thickness rectal prolapse): The entire wall of the rectum protrudes
• Internal prolapse (intussusception): The rectum folds in on itself but doesn’t protrude externally

Causes and Risk Factors of Rectal Prolapse

The primary cause of rectal prolapse is the weakening of the muscles and tissues that support the rectum. This weakening can be attributed to various factors:

• Chronic constipation and straining during bowel movements
• Long-term diarrhea
• Childbirth-related pelvic floor damage
• Neurological disorders affecting the pelvic region
• Age-related muscle weakness
• Malnutrition and vitamin deficiencies

Is age a significant factor in developing rectal prolapse? Indeed, individuals over 50 are at a higher risk, with women being more susceptible than men. However, younger people with chronic health conditions or those taking multiple medications may also be at risk.

Additional Risk Factors

Other factors that may increase the likelihood of developing rectal prolapse include:

• Cystic fibrosis
• Chronic obstructive pulmonary disease (COPD)
• Spinal cord injuries
• Parasitic infections
• Previous pelvic surgery
• Congenital abnormalities of the pelvic region

Recognizing the Symptoms of Rectal Prolapse

Identifying rectal prolapse early can lead to more effective treatment. The symptoms can vary in severity and may include:

• A bulge or protrusion from the anus, especially after coughing, sneezing, or lifting
• Mucus or blood in the stool
• Difficulty initiating or completing bowel movements
• Fecal incontinence or difficulty controlling bowel movements
• Anal pain, bleeding, or itching
• Feeling of incomplete evacuation after bowel movements
• Abdominal discomfort or pain

Do these symptoms always indicate rectal prolapse? Not necessarily. Many of these symptoms can also be associated with other anorectal conditions, such as hemorrhoids or anal fissures. Therefore, a proper medical evaluation is crucial for an accurate diagnosis.

Diagnostic Procedures for Rectal Prolapse

Diagnosing rectal prolapse involves a combination of physical examination and specialized tests. The process typically begins with a thorough medical history and a discussion of symptoms.

Physical Examination

During the physical exam, the healthcare provider may ask the patient to:

• Squat and strain as if having a bowel movement
• Cough or bear down while lying on their side

These maneuvers can help the doctor visualize the prolapse and assess its severity.

Specialized Diagnostic Tests

Several tests may be employed to confirm the diagnosis and evaluate the extent of the prolapse:

1. Defecogram: An X-ray taken during a bowel movement to assess rectal function
2. Anorectal manometry: Measures the strength of anal sphincter muscles
3. Colonoscopy: Allows visual examination of the entire colon
4. Barium enema: X-rays taken after introducing a contrast solution into the rectum
5. MRI: Provides detailed images of the pelvic floor muscles and surrounding structures
6. Endoanal ultrasound: Assesses the structure of the anal sphincters

How do these tests contribute to treatment planning? By providing a comprehensive view of the pelvic floor anatomy and function, these diagnostic procedures help healthcare providers determine the most appropriate treatment approach for each individual case.

Treatment Options for Rectal Prolapse

The treatment of rectal prolapse depends on various factors, including the severity of the condition, the patient’s overall health, and their age. Treatment approaches can be broadly categorized into non-surgical and surgical interventions.

Non-Surgical Management

For mild cases or patients who are poor surgical candidates, conservative treatments may be recommended:

• Dietary modifications to prevent constipation
• Pelvic floor exercises (Kegels) to strengthen supporting muscles
• Stool softeners or bulk laxatives to ease bowel movements
• Biofeedback therapy to improve bowel control

Surgical Interventions

When conservative measures fail or in cases of severe prolapse, surgery may be necessary. The choice of surgical procedure depends on the patient’s specific condition and overall health status.

Common surgical approaches include:

1. Abdominal rectopexy: The rectum is lifted and secured to the sacrum
2. Perineal rectosigmoidectomy: The prolapsed rectum is removed and the remaining rectum is reattached
3. Delorme’s procedure: The mucosa of the prolapsed rectum is removed and the muscular layer is folded
4. Altemeier procedure: The prolapsed rectum is removed and the colon is attached to the anal canal

What factors influence the choice of surgical procedure? The decision depends on the patient’s age, overall health, the extent of the prolapse, and the surgeon’s expertise. Minimally invasive laparoscopic or robotic-assisted techniques are increasingly being used, offering shorter recovery times and reduced post-operative pain.

Preventing Rectal Prolapse: Lifestyle Modifications and Risk Reduction

While not all cases of rectal prolapse can be prevented, certain lifestyle modifications can help reduce the risk or manage the condition:

• Maintaining a high-fiber diet to prevent constipation
• Staying adequately hydrated
• Avoiding straining during bowel movements
• Practicing pelvic floor exercises regularly
• Managing chronic cough or other conditions that increase abdominal pressure
• Maintaining a healthy weight to reduce pressure on the pelvic floor

Can these preventive measures reverse existing rectal prolapse? While they may not reverse established prolapse, these measures can help prevent progression and reduce symptom severity in mild cases.

Living with Rectal Prolapse: Coping Strategies and Quality of Life

Rectal prolapse can significantly impact a person’s quality of life, affecting both physical comfort and emotional well-being. Developing effective coping strategies is crucial for managing the condition and maintaining a positive outlook.

Emotional and Psychological Impact

The embarrassment and discomfort associated with rectal prolapse can lead to:

• Social isolation
• Anxiety about public outings
• Depression
• Reduced self-esteem

How can patients address these psychological challenges? Seeking support from mental health professionals, joining support groups, and open communication with family and friends can be beneficial in managing the emotional aspects of the condition.

Practical Management Tips

For individuals living with rectal prolapse, the following strategies can help manage symptoms and improve daily life:

• Planning bathroom visits to reduce the risk of unexpected prolapses
• Carrying a “prolapse kit” with clean supplies for managing prolapses in public
• Wearing supportive undergarments or specialized devices to help retain the prolapse
• Adapting exercise routines to avoid high-impact activities that may exacerbate symptoms
• Exploring complementary therapies like acupuncture or yoga for stress reduction and pelvic floor strengthening

Advances in Rectal Prolapse Research and Treatment

The field of colorectal surgery continues to evolve, with ongoing research aimed at improving treatment outcomes and patient quality of life. Recent advances and areas of active investigation include:

Minimally Invasive Surgical Techniques

Laparoscopic and robotic-assisted surgeries are becoming increasingly refined, offering benefits such as:

• Smaller incisions and reduced scarring
• Shorter hospital stays
• Faster recovery times
• Reduced post-operative pain

Biomaterials and Mesh Technologies

Research into new biomaterials and improved surgical mesh designs aims to enhance the durability of surgical repairs while minimizing complications.

Regenerative Medicine Approaches

Emerging therapies using stem cells or growth factors to regenerate and strengthen pelvic floor tissues are under investigation, potentially offering new treatment options in the future.

Improved Diagnostic Tools

Advanced imaging techniques and functional tests are being developed to provide more accurate diagnoses and better guide treatment decisions.

How might these advances impact patient care in the coming years? As research progresses, patients may benefit from more personalized treatment approaches, improved surgical outcomes, and potentially new non-surgical options for managing rectal prolapse.

Long-Term Outlook and Follow-Up Care for Rectal Prolapse Patients

The long-term prognosis for individuals with rectal prolapse varies depending on the severity of the condition, the chosen treatment approach, and the patient’s overall health. Understanding the potential outcomes and the importance of ongoing care is crucial for managing expectations and ensuring the best possible results.

Post-Treatment Outcomes

For patients undergoing surgical treatment, the success rates are generally high, with many experiencing significant improvement in symptoms and quality of life. However, it’s important to note that:

• Recurrence rates vary depending on the surgical technique used and individual patient factors
• Some patients may experience temporary changes in bowel function following surgery
• Ongoing pelvic floor exercises and lifestyle modifications are often necessary to maintain results

Follow-Up Care

Regular follow-up care is essential for monitoring recovery and detecting any potential complications or recurrence. This typically involves:

1. Scheduled post-operative check-ups
2. Ongoing pelvic floor assessments
3. Colonoscopies as recommended for age-appropriate cancer screening
4. Nutritional counseling to maintain optimal bowel health

What role does patient compliance play in long-term outcomes? Adherence to post-treatment recommendations, including dietary guidelines, exercise regimens, and follow-up appointments, is crucial for maintaining the benefits of treatment and preventing recurrence.

Potential Complications and Management

While most patients experience positive outcomes, it’s important to be aware of potential complications that may arise post-treatment:

• Constipation or fecal incontinence
• Wound infection or healing issues
• Sexual dysfunction
• Recurrence of prolapse

Prompt recognition and management of these complications are essential for maintaining quality of life and preventing further issues.

Ongoing Research and Future Directions

As our understanding of rectal prolapse continues to evolve, ongoing research aims to:

• Develop more effective preventive strategies
• Improve long-term outcomes of surgical interventions
• Explore novel non-surgical treatments
• Enhance quality of life for patients living with the condition

How can patients stay informed about new developments in rectal prolapse treatment? Maintaining open communication with healthcare providers, participating in patient support groups, and staying abreast of reputable medical information sources can help patients remain informed about the latest advancements in rectal prolapse management.

Rectal Prolapse | Cedars-Sinai

ABOUT

CAUSES
DIAGNOSIS

TREATMENT

NEXT STEPS

What is rectal prolapse?

Your rectum is the last part of your colon. It’s where stool forms before you have
a
bowel movement. Rectal prolapse is when part of the rectum bulges out of the anus.

At first, a prolapse may happen only after a bowel movement. The
prolapsed part of the rectum may then slip back through the anal canal on its own.
Over time, the prolapse may become more severe and may need surgery.

What causes rectal prolapse?

Rectal prolapse is most often caused by weakening of the muscles
that support the rectum. This can happen from constipation, damage from giving
birth, or defects in the pelvis or lower gastrointestinal tract.

Who is at risk for rectal prolapse?

Rectal prolapse is more common in people age 50 and older. Women
are more likely to have the condition than men. Younger people with the condition
often have chronic health conditions and take several medicines.

A person is more at risk for rectal prolapse if they have any of the below:

• A long history of constipation
• Straining to have bowel movements
• Long-term (chronic) diarrhea
• Laxative abuse
• Childbirth
• Spinal cord problems or previous stroke
• Cystic fibrosis
• Dementia

What are the symptoms of rectal prolapse?

Symptoms can occur a bit differently in each person. They can include:

• Feeling a bulge from the anus after coughing, sneezing, or
  lifting
• Having mucus in your stool
• Straining to start or finish a bowel movement
• Having incomplete bowel movements
• Having belly (abdominal) discomfort or pain
• Bleeding from the rectum
• Trouble controlling bowel movements (fecal
  incontinence)
• Having to push the prolapse back into the anus by hand
• Feeling pressure in your rectum
• Being constipated
• Having anal pain, bleeding, or itching

The symptoms of rectal prolapse may look like other health conditions. Always see
your healthcare provider for a diagnosis.

How is rectal prolapse diagnosed?

Your healthcare provider will ask about your symptoms and health
history. Your provider will give you a physical exam. You may be asked to squat and
strain as if you are having a bowel movement. You may also have tests such as:

• Defecogram. This test is a
  type of X-ray taken during a bowel movement.
• Anorectal manometry. A pressure-measuring tube is placed in the rectum.
  This is done to measure how well the muscles that control bowel movements are
  working.
• Colonoscopy. A flexible tube with a camera is placed inside the rectum so
  the healthcare provider can do a visual exam.
• Barium enema. X-ray
  pictures are taken after a type of chalky contrast solution is placed in the
  rectum.
• MRI. A special MRI can be done during simulated bowel movement.
• Special urologic or
  gynecologic evaluations.
  Your provider will also assess the rest of your
  pelvic floor. Your provider will look for weakness or signs of other organs
  prolapsing. These might be the bladder or uterus. This test is also done if a
  woman has both rectal prolapse and uterine prolapse.

How is rectal prolapse treated?

Treatment will depend on your symptoms, your age, and your general health. It will
also depend on how severe the condition is. Treatment often begins with steps to
prevent constipation and straining.

If your rectal prolapse is severe and interferes with your quality of life, your
healthcare provider may advise surgery. Types of surgery include:

• Repair through the abdomen. A cut is made through the lower belly. The
  rectum is attached to the lower part of the backbone to support it and keep it
  in place.
• Repair through the rectum. Your surgeon removes the part of the rectum
  that has prolapsed and reconnects the remaining parts.
• Repair with both these methods. These 2 methods may be combined to treat
  your prolapse.

Talk with your healthcare providers about the risks, benefits, and possible side
effects of all treatments.

What are possible complications of rectal prolapse? 

The 2 main possible complications are:

• The rectal prolapse can’t be pushed back into the rectum. It
  can cause the blood supply to the prolapse to be cut off. This is called
  strangulation. It’s painful and needs emergency treatment.
• The rectal prolapse happens again. This is common. Following
  your healthcare provider’s advice on lifestyle changes can help prevent it
  happening again. That means preventing constipation. Lifestyle changes may
  include eating a high-fiber diet and drinking enough water.

Can rectal prolapse be prevented?

Not straining during a bowel movement can help prevent the condition. Follow your
healthcare provider’s advice for ways to prevent constipation.

How to manage rectal prolapse

These tips for managing rectal prolapse before or after surgery may help:

• Don’t do any activities that increase pressure in your rectal area. This
  includes straining to have a bowel movement or heavy lifting.
• If you have an ongoing cough, have it treated by your
  healthcare provider. They may also urge you to stop smoking.
• Eat at least 5 servings of fruits and vegetables every day. A high-fiber diet
  can help prevent constipation and straining.
• Drink 6 to 8 glasses of water every day.
• If you are constipated, ask your healthcare provider about stool softeners or
  laxatives.
• Stay active and get regular exercise. If you are overweight, take steps to get
  to a healthy weight.

When should I call my healthcare provider?

Call your healthcare provider if you have any of these symptoms:

• Fever
• Chills
• Swelling
• Bleeding from the anus
• Fluid leaking from the anus
• Constipation
• Loss of control of bowel movements (fecal incontinence)
• A rectal prolapse that happens again

Key points about rectal prolapse

• Rectal prolapse is when part of the rectum bulges out of the anus.
• It is most often caused by weakening of the muscles that
  support the rectum. It can happen from constipation, damage from giving birth,
  or defects in the pelvis or lower gastrointestinal tract.
• At first, it may happen only after a bowel movement. But
  over time, the prolapse may become more severe and may need surgery.
• Symptoms can include feeling a bulge after coughing, sneezing, or lifting.
• Treatment often begins with steps to prevent constipation and straining. If your
  rectal prolapse is severe and interferes with your quality of life, your
  healthcare provider may advise surgery.
• Follow your healthcare provider’s advice for ways to prevent constipation.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider
  tells you.
• At the visit, write down the name of a new diagnosis and any
  new medicines, treatments, or tests. Also write down any new instructions your
  provider gives you.
• Know why a new medicine or treatment is prescribed and how
  it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could
  mean.
• Know what to expect if you do not take the medicine or have the test or
  procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for
  that visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Jen Lehrer MD

Medical Reviewer: Rita Sather RN

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Rectal Prolapse | Johns Hopkins Medicine

Your rectum is the lower part of your colon, where stool forms. If the rectum drops out of its normal place within the body and pushes out of the anal opening, the condition is called rectal prolapse.

In the early stages, a prolapse may happen only after a bowel movement. The protruding rectum may then slip back through the anal canal on its own. Over time, however, the prolapse may become more severe and could require surgery.

Causes

Rectal prolapse is usually caused by a weakening of the muscles that support the rectum.

Symptoms

Symptoms of rectal prolapse include:

• Feeling a bulge after coughing, sneezing, or lifting

• Having mucous discharge in your stool

• Pain and rectal bleeding

• Fecal incontinence

• Having to push the prolapse back into the anus by hand

• Feeling pressure in your rectum

• Being constipated

• Having anal pain, bleeding, or itching

Risk factors

Anyone can develop rectal prolapse, but women are more likely to have the condition than men.

These are some conditions that may increase your risk for developing a rectal prolapse:

• A long history of constipation

• Straining to have bowel movements

• Chronic diarrhea

• Laxative abuse

• Childbirth

• Spinal cord problems or previous stroke

• Cystic fibrosis

• Aging or dementia

Diagnosis

Your healthcare provider will be able to diagnose rectal prolapse with a medical history and a physical exam. You may be asked to squat and strain as if you are having a bowel movement. Your healthcare providers may also do other tests to confirm the diagnosis. Tests may include:

• Videofecogram. A type of X-ray taken during a bowel movement.

• Anorectal manometry. A pressure-measuring tube placed inside the rectum to measure how well the muscles that control bowel movements are working.

• Colonoscopy. A flexible tube with a camera placed inside the rectum so the healthcare provider can do a visual exam.

• Barium enema. X-ray pictures are taken after a type of contrast solution is placed in the rectum.

Treatment

Treatment often begins with steps to avoid constipation and straining. If your rectal prolapse is severe enough and interferes with your quality of life, your healthcare provider will probably recommend surgery.

Types of surgery include:

• Repair done through the abdomen. A cut is made through the lower belly, and the rectum is attached to the lower part of the backbone to support it and keep it in place.

• Repair done through the rectum. During this operation, your surgeon must remove the part of the rectum that has prolapsed and join the two ends.

• Repair done by combining these techniques

Complications

These are the two main types of complications:

• A rectal prolapse that can’t be pushed back into the rectum. This can cause the blood supply to the prolapse to be cut off. This complication is called strangulation. It’s painful and needs emergency treatment.

• A rectal prolapse that happens again. This can happen up to 40% of the time. Following your healthcare provider’s advice on lifestyle changes can help prevent recurrence. This includes eating a high-fiber diet and drinking enough water.

When to call the healthcare provider

Call your healthcare provider if you have any of these symptoms:

• Fever

• Chills

• Redness

• Swelling

• Bleeding

• Discharge

• Constipation

• Fecal Incontinence

Managing rectal prolapse

If you are recovering from rectal prolapse surgery, make sure to take your pain medicine as directed by your healthcare provider. Finish all antibiotics and don’t take any over-the-counter medicine without talking with your surgeon.

These tips for managing rectal prolapse before or after recovery from surgery may help:

• Avoid any activities that increase pressure in your rectal area, like straining to have a bowel movement or heavy lifting, for at least 6 months.

• Have any persistent cough treated by your healthcare provider. Your healthcare provider may also urge you to stop smoking.

• Eat at least 5 servings of fruits and vegetables every day. A high-fiber diet will help prevent constipation and straining.

• Drink 6 to 8 glasses of water every day.

• If you are constipated, ask your healthcare provider if you should take a stool softener or a bulk laxative.

• Stay active and get regular exercise. If you are overweight, try to get back to a healthy weight.

Prolapse of the rectum – methods of treatment, stages of prolapse, symptoms and complications

Prices Doctors Our centers

Classification Symptoms Complications Diagnosis Treatment methods Prognosis Prevention

Rectal prolapse or rectal prolapse is a pathological condition
which is accompanied by the release of the mucosa beyond the boundaries of the anal sphincter. All layers of the diastal layer fall out
segment of the large intestine. The protruding segment in this case ranges from 2 to 20 centimeters and even more.

Often this disease is diagnosed in men, they account for 70% of clinical cases. In 30% pathology
occurs in women. Prolapse is predominantly formed in people of working age from 20 to 50 years, however
often occurs in babies 3-4 years old due to the specifics of the anatomical and physiological characteristics of the child
organism.

Causes of weakening of muscles and ligaments, which leads to prolapse of rectal nodes:

• hereditary predisposition;
• incorrect anatomical structure of the pelvic bones, shape and rectum and sigmoid colon, intestinal wall;
• prolonged defecation disorders: diarrhoea, constipation;
• excessive straining during urination;
• parasitic intestinal infections;
• injuries of pelvic nerves and muscles;
• regular excessive physical activity, hard work, heavy lifting;
• heavy or multiple childbirth in women;
• diseases of the nervous system.

Classification

The official classification of human rectal prolapse is used by specialists when developing a therapeutic
scheme. It provides for the distribution of pathology into three stages:

• Stage 1 (compensated) – the intestine falls out only during defecation and returns on its own
  in a natural position;
• stage 2 (subcompensated) – prolapse occurs during bowel movements and at high
  physical exertion, accompanied by insufficiency of the anal sphincter;
• stage 3 (decompensated) – prolapse of the rectum is observed even when walking, coughing, sneezing,
  accompanied by incontinence of feces, gases, severe insufficiency of the sphincter.

Specialists also distinguish two types of rectal prolapse:

• Hernia – Douglas pouch and anterior wall of the rectum move down, with weak muscles
  pelvic floor and constant high intra-abdominal pressure lead to prolapse of the intestine into the anal canal. Through
  time, all the walls are involved in the pathological process, and the sagging increases.
• Invaginated or internal prolapse – part of the rectum or sigmoid colon is embedded in the lumen
  other part of the intestine. In this case, the organ does not go outside, and the main symptom of pathology is regular
  strong pain attacks.

Symptoms

Symptoms of pathology occur both gradually and suddenly. An unexpected start is associated with sharp and intense
loads, stress. After such an episode, the rectum falls out, and the person feels sharp pains in the abdomen, up to
to pain shock.

More often, however, rectal prolapse develops gradually. As the pathology progresses, it becomes more
pronounced and signs of loss:

• sensation of a foreign body in the anus;
• abdominal pain that worsens with walking, exercise, defecation;
• incontinence, inability to hold back gases, stools;
• frequent false urge to defecate;
• sensation of incomplete bowel movements;
• frequent urination;
• secretion of mucus, blood from the anus;
• the formation of a solitary ulcer, mucosal edema (with internal prolapse).

Untreated complications

The most dangerous complication that occurs when prolapse is ignored is the infringement of the prolapsed segment of the intestine.
Infringement appears with untimely intervention or when you try to set the prolapse on your own.
Accompanied by edema, increasing ischemia, impaired blood supply. If you do not seek help in time,
the outer portion of the tissues will be affected by necrosis (tissue necrosis).

Another complication that pathology leads to is solitary ulcers. Such wounds cause over time
bleeding leading to perforation.

In advanced stages of internal prolapse, acute intestinal obstruction and peritonitis often occur. These are dangerous
conditions that pose a threat to human life.

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Diagnostics

A proctologist can diagnose rectal prolapse and the degree of prolapse of the intestine even without examination and analysis
symptoms. The prolapsed part of the organ has a cone-shaped, cylindrical or spherical shape, painted in
bright red or bluish tint. The mucous membrane is markedly swollen and bleeds on contact. On
in the early stages, you can set the intestine and restore the normal state of the tissues. If at the time of examination the prolapse is not
observed, the patient is offered to strain to provoke a prolapse.

During a digital examination, the doctor determines the tone of the sphincter, differentiates the disease from hemorrhoids and anal
polyps. After that, for an accurate diagnosis, identification of complications and the exact stage of the disease,
instrumental diagnostics, which includes:

• colonoscopy – to identify the causes of the pathology;
• barium enema – to detect functional changes in the colon;
• defectography (proctography) – to determine the degree of prolapse;
• anorectal manometry – to assess muscle function;
• endoscopic examination (sigmoidoscopy) – to detect intussusception, the presence of ulcers;
• endoscopic biopsy with tissue examination – is prescribed if a solitary ulcer is detected to exclude
  oncology of the rectum;
• gynecological examination – for women.

Methods of treatment of rectal prolapse

Conservative approaches are used only in the earliest stages of the disease. The main purpose of such events is
normalize stool and eliminate increased intra-abdominal pressure. Clinical recommendations include:

• high fiber diet;
• drinking plenty of water;
• laxatives;
• drugs to increase peristalsis;
• neurostimulation, which helps to regain control over the muscles in case of impaired innervation.

Surgical methods of treatment bring results in the later stages of the development of prolapse, as well as in cases where
when conservative therapy fails. There are many operations that help get rid of
pathology. They include:

• excision of the prolapsed section of the rectum;
• bowel fixation;
• plastic surgery of the anal canal, pelvic floor;
• colon resection;
• combined methods.

Resection of the prolapsed section is more often done predominantly by surgery
Delorme. The surgeon removes the mucous membrane and forms a new muscle layer in the anal canal area. Operation
has a low invasiveness and is suitable even for older patients with serious chronic pathologies.
Less commonly, resection of the prolapsed lobe is done by patchwork cutting according to Nelaton or circular removal according to Mikulich.

Among fixation methods, rectopexy is considered the most effective –
an operation in which the pelvic section of the intestine is attached to the walls of the pelvis, thus restoring the correct
organ anatomy. The operation is performed on patients under 50-55 years of age. In 97% of cases, organ prolapse is eliminated.

Anal plastic surgery helps narrow the anus with surgical sutures and wires,
synthetic materials. However, this group of methods has a high risk of recurrence, so it is rarely used.

Resection of the distal colon is necessary if the patient has a solitary ulcer or necrosis. Often
such an operation is combined with fixing operations.

SM-Clinic surgeons have experience in performing various types of prolapse surgery. Our clinicians in
are fluent in modern surgical techniques and successfully help patients get rid of pathological
bowel prolapse.

Forecast

Surgical treatment brings a positive result without recurrence in 80% of cases. In 70-75% of patients, as a result
treatment restores the evacuation capacity of the intestine. At the same time, 25-30% of patients develop disorders
transitory function.

Moreover, the earlier the patient seeks help, the more favorable the prognosis will be. Unfortunately, patients often go to
doctor only in the later stages of the development of pathology, when prolapse is already obvious, bowel functions are impaired, and in
tissues began to undergo irreversible changes. In this case, the risk of developing life-threatening complications increases in
times.

Prophylaxis

To prevent the disease, as well as to prevent relapse, doctors recommend eliminating factors that increase
intra-abdominal pressure and cause weakness of the pelvic floor muscles:

• avoid injuries in the pelvis, sacrum;
• physical activity, stress;
• treat constipation, flatulence, diarrhea;
• do not start urolithiasis, prostate adenoma;
• to prevent hacking agonizing cough.

Pathology develops as a result of a combination of several factors, so for prevention it is necessary to minimize all
risks.

Specialists in this field 21 doctors

Leading doctors 6 doctors

Petrushina Marina Borisovna

Surgeon, proctologist

Work experience: 42 years

Udarnikov, 19

m. Ladozhskaya

Make an appointment

Aramyan David Surenovich

Surgeon, coloproctologist, oncologist, mammologist

Work experience: 13 years reception

Kolosovsky Yaroslav Viktorovich

Surgeon, mammologist, oncologist

Work experience: 17 years

Dybenko, 13k4

m. make an appointment

Karapetyan Zaven Surenovich

Coloproctologist, surgeon and phlebologist

Work experience: 15 years

Dunaisky, 47

Dunayskaya metro station

Marshala Zakharov, 20

Leninskiy avenue metro station

Make an appointment 90 003 Andrey Shishkin

Surgeon, phlebologist, proctologist. Candidate of Medical Sciences

Work experience: 13 years

Dunaysky, 47

Dunayskaya metro station

Make an appointment

Maslennikov Dmitry Yurievich

Surgeon, proctologist, mammologist

Work experience: 16 years

Udarnikov, 19

Ladozhskaya metro station

Dybenko, 13k4

Dybenko street metro

Make an appointment

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+15 doctors

Other doctors 15 doctors

Ardashov Pavel Sergeevich

Coloproctologist-surgeon

Work experience: 9 years

Udarnikov, 19

persons Dybenko

Make an appointment

Bulkina Maria Sergeevna

Coloproctologist, surgeon

Work experience: 11 years

Dunaysky, 47

Dunayskaya metro station

Vyborgskoe shosse, 17

Prosveshcheniya metro station 9000 3

Make an appointment

Grinevich Vladimir Stanislavovich

Surgeon, oncologist, mammologist, coloproctologist

Work experience: 27 years

Vyborgskoe shosse, 17

m.
Klyuev Andrey

Operating proctologist

Work experience: 16 years

Malaya Balkanskaya, 23

Kupchino metro station

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Nekrasov Roman Aleksandrovich

Coloproctologist and surgeon

Work experience: 8 years

Udarnikov, 19

Ladozhskaya metro station

Marshala Zakharov, 20

Leninsky pr. -t

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Petrova Vitalina Vasilievna

Operating proctologist

Work experience: 12 years

Vyborgskoe shosse, 17

Prospekt Prosveshcheniya metro station

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Senko Vladimir Vladimirovich

Head of the Center for Surgery and Oncology

Work experience: 23 years Leninsky Prospekt

Vyborgskoe shosse, 170003

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Sinyagina (Nazarova) Maria Andreevna

Surgeon, proctologist

Work experience: 8 years

Marshala Zakharova, 20

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Sokolova Anna Sergeevna

Coloproctologist, surgeon. Candidate of Medical Sciences.

Work experience: 13 years

Malaya Balkanskaya, 23

Kupchino metro station

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Sol Anton Aleksandrovich

Work experience: 15 years

Vyborgskoye shosse, 17

metro Prosveshcheniya

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Fomenko Nikolai Aleksandrovich

Surgeon, proctologist, oncologist

Work experience: 15 years

Marshal Zakharova, 20

m. Leninsky pr-t

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Khangireev Alexander Bakhytovich

Surgeon, oncologist, coloproctologist

Work experience: 13 years

Udarnikov, 19

Ladozhskaya metro station

Dunaiskiy, 47

Dunaiskaya metro station

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Khokhlov Sergey Viktorovich

Surgeon, oncologist, coloproctologist

Work experience: 28 years old

Vyborg highway, 17

m. Prospekt Prospect

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Chuprina Susanna Vladimirovna

Coloproctologist of the highest category

Work experience: 22 years

Udarnikov, 19

Ladozhskaya metro station

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Yalda Ksenia Davidovna

Coloproctologist

Work experience: 11 years

Malaya Balkanskaya, 23

Kupchino metro station

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Rectal prolapse (rectal prolapse) – symptoms, causes, types, prevention and treatment methods in the “SM-Clinic”

This disease is treated by Proctologist

• What is it?
• About disease
• Types of intestinal prolapse
• Symptoms of bowel prolapse
• Causes of bowel prolapse
• Diagnosis of rectal prolapse
• Expert opinion
• Treatment of bowel prolapse
• Surgical treatment
• Prophylaxis
• Rehabilitation
• Q&A

About the disease

Prolapse of the rectum is one of the severe pathologies of the intestine, in which all layers of the intestinal wall turn out through the anus. Most often, this pathological process occurs against the background of weakening of the pelvic muscles. One of the characteristic features of this pathological phenomenon is the squeezing of the vessels of the submucosal layer by the walls of the anal canal. As a result of prolonged compression, the mucosa acquires a bluish tint and may necrotize (die off) due to the cessation of blood flow.

Prolapse is often preceded by internal intussusception. This is a condition in which the protrusion of the superior parts of the rectum into the lumen of the lower ones occurs, but they do not go beyond the anal canal.

Types of intestinal prolapse

The generally accepted classification of rectal prolapse is based on the severity of symptoms, neglect and severity of the disease. There are three stages of the pathological process:

• first stage: the rectum falls out only during defecation;
• second stage: the lower part of the intestine begins to fall out during physical exertion.
• third stage: bowel prolapse occurs when walking or when moving to an upright position.

Symptoms of bowel prolapse

At the initial stage of the development of the pathology, when only the mucous membrane falls out, it is easy to set it yourself. At this time, there are no unpleasant symptoms, but if treatment is not started, the course of the disease will worsen and the prolapse will become complete. In this case, the prolapsed part of the intestine has a cylindrical shape and resembles a tumor. If it is not set for a long time, the mucous membrane swells, ulcerates, bleeds. Other signs of bowel prolapse include:

• fecal incontinence;
• swelling of the anus;
• secretion of mucus from the anus;
• decreased tone of the anal sphincter;
• spotting or bleeding from the anus;
• sensation of fullness in the anus as if there was a foreign body in it.

Pain syndrome is not a characteristic symptom of rectal prolapse. Pain may appear in cases of infringement of part of the intestine or with significant prolapse.

Causes of bowel prolapse

Rectal prolapse may occur due to a combination of several adverse factors. The exact causes of bowel prolapse have not been established, but experts have identified a wide range of risk factors. The main ones include anatomical and constitutional features, which include:

• weak ligamentous apparatus;
• large size of the pelvic pocket of the peritoneum;
• excessive mobility of the rectum and sigmoid colon, etc.

Not the last place in the development of pathology is the genetic factor and acquired degenerative changes in the muscles of the obturator apparatus and the intestinal wall.

Direct causes of bowel prolapse include:

• severe diarrhea;
• dramatic weight loss;
• strenuous exercise;
• prolonged constipation with excessive straining to empty the bowels;
• blunt trauma to the abdomen (a sharp increase in intra-abdominal pressure provokes eversion of the rectum outward through the anus, like a hernia.

The development of intestinal prolapse can be promoted by trauma to the spinal cord with damage to the cauda equina (a bundle of spinal nerves extending from its final section), age-related tissue changes, and the consequences of neurological diseases. The risk group includes women who have given birth and the elderly.

Get advice

If you experience these symptoms, we advise you to make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:

+7 (495) 292-39-72

Request a call back
Book online

Why SM-Clinic?

1

Treatment according to clinical guidelines

2

Comprehensive assessment of the nature of the disease and treatment prognosis

3

Modern diagnostic equipment and own laboratory

4

High level of service and balanced pricing policy

Diagnosis of rectal prolapse

An experienced proctologist in most cases can make a diagnosis already at the initial examination. To clarify it and choose the right treatment protocol, an assessment of the severity of the disease is required. For this purpose, the patient is prescribed additional instrumental studies. To determine the severity of intestinal prolapse allow:

• anal manometry, this test is designed to measure the strength of the anal sphincter muscles and assess holding function;
• transrectal ultrasound, with its help, the doctor assesses the structure and shape of the muscles of the anal sphincter and surrounding tissues;
• defecography (proctography), this study is used to assess how well the rectum holds stool and empties;
• colonoscopy, with the help of this diagnostic procedure, a specialist can visually inspect the entire internal surface of the intestine and identify problems present in it;
• anal electromyography, this test allows you to identify nerve damage that leads to improper functioning of the anal sphincter, it also determines the coordination of the anal muscles and intestines.

If necessary, specialists of an adjacent profile, for example, neurologists, are connected to the diagnosis.

Expert opinion

Intestinal prolapse is a serious pathology that, having appeared once, does not disappear, but continues to gradually progress. If you do not start treatment, the prolapsed part of the intestine will constantly increase, and the anal sphincter will stretch. The disease itself is an ordeal for a person, but the consequences of rectal prolapse can be extremely dangerous. The most formidable complications are:

• acute intestinal obstruction;
• strangulation of parts of the intestine;
• rectal bleeding;
• mucosal ulcers;
• peritonitis.

To prevent the transition of the pathology into a more severe form or the development of complications, you should consult a doctor at the first signs of prolapse, and then do not delay the planned operation. The sooner doctors fix the problem, the better the results will be and the faster the recovery will be. Patients after the operation restore social activity, psychological complexes disappear and sexual life normalizes.

Igor Peresada

Coloproctologist, Candidate of Medical Sciences, Leading Coloproctologist of the Holding, Leading Specialist

Treatment of bowel prolapse

In the early stages of the pathology, treatment can be conservative, but experience shows that these methods do not guarantee complete success. Surgical intervention is considered the best option.

Conservative treatment

This therapy is carried out before surgery and consists in normalizing the stool in order to avoid constipation in the postoperative period. First of all, the patient’s diet is changed, enriching it with coarse fiber and strengthening the drinking regimen. If the stool is not restored, the doctor selects suitable laxatives of physiological action.

Surgical treatment

Several surgical techniques are used to treat rectal prolapse.

• Rectosacropexy. It is performed using an alloprosthesis, a mesh allograft designed to hold the intestine in a predetermined position. Surgical manipulations consist in the fact that, first of all, the intestine is raised to the level of the muscles of the anus, then it is pulled up and fixed by means of a mesh allograft to the presacral fascia located between the sacrum and the rectum.
• Operation Kümmel. This surgical manipulation consists in fixing the intestine raised to the promontory of the sacrum with interrupted sutures.

Abdominal surgery can be performed both through incisions, open access, and minimally invasive laparoscopic method, through 3 small punctures.

There are several surgeries that can be performed without external incisions. All manipulations are carried out through the anus.

• Delorme operation. This is the excision and removal of the protruding part of the intestinal mucosa and the subsequent creation of a muscle cuff in its place, which will hold it, protecting it from falling out.
• Operation Altmeer. This is the removal of the prolapsed part of the rectum with the formation of a coloanal anastomosis (connection of the remaining part of the intestine to the anal canal.

Surgery allows most patients to completely get rid of the negative symptoms of rectal prolapse.

Prevention

The main way to prevent bowel prolapse is to take measures to ensure normal bowel function. Doctors recommend that you carefully monitor your diet. The menu should include more bran, dairy products, coarse fiber. In addition, heavy lifting and excessive physical activity should be avoided, especially with a high risk of developing prolapse.

Rehabilitation

The duration of hospitalization and full rehabilitation depends on the type of operation. After surgery, it is important to exclude overexertion, control the stool, and prevent constipation and severe straining. The normal functioning of the digestive tract is ensured by a balanced diet. The diet of the operated patient is made up individually, taking into account his needs and wishes. It is also necessary to abandon weight lifting, intense physical activity, sexual intercourse, overheating and hypothermia, visiting the pool and swimming in open water.

In addition, after surgery, patients should visit a proctologist to assess the recovery process and early diagnosis of recurrence. The frequency of visits is determined by the doctor.

Q&A

Yes, but only at the initial stage. If you do not engage in treatment, the intestines will begin to fall out even when you cough.

This pathology responds well to treatment, and recurrences occur in only 15% of cases.

Gaivoronskaya S. S., Vasiliev S. V., Chania Z. D., Popov D. E., Nedozimovany A. I. Possibilities of complex treatment of rectal prolapse // Tomsk State University Journal. hir.. 2007. No. 2.

Alexey Ildarovich Musin, Leonid Alekseevich Blagodarny, Sergey Alekseevich Frolov Modern concept of surgical treatment of rectal prolapse // Astrakhan Medical Journal. 2011. No. 4.

SS Imanova, BM Zeynalov The choice of surgical tactics for rectal prolapse // Biomedicine (Baku). 2017. No. 2.

Vasiliev SV, Popov DE, Gaivoronskaya SS Comparative evaluation and selection of optimal methods of surgical treatment of patients with rectal prolapse // Acta Biomedica Scientifica. 2005. No. 4.

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