What is rectal prolapse and how does it affect women. How can pregnancy and childbirth increase the risk of rectal prolapse. What are the main symptoms of rectal prolapse to watch out for. How is rectal prolapse diagnosed and treated in women.

Understanding Rectal Prolapse: Definition and Types

Rectal prolapse occurs when the rectum, the final segment of the intestine, slips out of its normal position within the body. This condition can range from mild to severe, depending on how much of the rectal tissue protrudes. There are three main types of rectal prolapse:

• Internal prolapse (intussusception): The rectum telescopes into itself but remains inside the body.
• Partial prolapse: Some rectal tissue bulges outside the anus.
• Complete (external) prolapse: The entire rectum protrudes outside the body.

While rectal prolapse affects only about 0.25% of the general population, it is more common in women, especially those over 50 who have given birth multiple times.

Risk Factors for Rectal Prolapse in Women

Several factors can increase a woman’s risk of developing rectal prolapse:

• Pregnancy and childbirth
• Vaginal tears during delivery
• Chronic constipation or diarrhea
• Prolonged straining during bowel movements
• Aging and menopause
• Chronic cough (e.g., from COPD)
• Previous pelvic surgery

Pregnancy is a significant risk factor for rectal prolapse. The physical changes that occur during pregnancy, including the softening of ligaments and support structures, as well as the added weight of the fetus, can contribute to weakening of the pelvic floor muscles.

How does childbirth impact the risk of rectal prolapse?

Childbirth, especially vaginal delivery, can further increase the risk of rectal prolapse. The process of giving birth can cause injury to the anus and pelvic floor muscles. Surgically assisted vaginal births, such as those using forceps or vacuum assistance, may place even more stress on the body and potentially cause damage to the pelvic floor support structures.

Recognizing the Symptoms of Rectal Prolapse

Rectal prolapse can present with various symptoms, ranging from subtle to more noticeable signs:

• Pressure or bulging sensation in the anus
• Feeling of pelvic heaviness after bowel movements
• Pain, itching, or bleeding in the anal area
• Fecal incontinence or leakage of mucus
• Sensation of something falling out of the anus
• Visible protrusion of pink, swollen tissue from the anus (in cases of complete prolapse)

Can rectal prolapse be mistaken for hemorrhoids?

Yes, rectal prolapse can sometimes be mistaken for hemorrhoids, as both conditions can cause similar symptoms such as pain, itching, and bleeding in the anal area. However, hemorrhoids typically involve only small areas of swollen tissue, while a rectal prolapse involves a more significant protrusion of the rectal wall.

Diagnosing Rectal Prolapse in Women

If you suspect you may have rectal prolapse, it’s essential to seek medical attention promptly. A healthcare provider will typically perform the following steps to diagnose the condition:

1. Medical history review: The doctor will ask about your symptoms, medical history, and risk factors.
2. Physical examination: This may include a visual inspection of the anal area and a digital rectal exam.
3. Imaging tests: In some cases, the doctor may order additional tests such as defecography, colonoscopy, or MRI to assess the extent of the prolapse and rule out other conditions.

What is defecography and how is it used in diagnosing rectal prolapse?

Defecography is an imaging technique that allows doctors to observe the rectum and pelvic floor muscles during the process of defecation. This test involves taking X-ray or MRI images while the patient expels a contrast material, providing valuable information about the function of the rectum and surrounding structures. Defecography can help diagnose rectal prolapse and assess its severity.

Treatment Options for Rectal Prolapse

The treatment approach for rectal prolapse depends on the severity of the condition and the patient’s overall health. Options may include:

Conservative Treatments

• Dietary changes to improve bowel function
• Pelvic floor exercises (Kegels) to strengthen supporting muscles
• Stool softeners or laxatives to reduce straining during bowel movements
• Biofeedback therapy to improve muscle coordination

Surgical Interventions

In cases where conservative treatments are ineffective or the prolapse is severe, surgery may be necessary. Surgical options include:

• Abdominal rectopexy: The rectum is lifted and secured to the sacrum (lower back bone)
• Perineal rectosigmoidectomy: A portion of the rectum and sigmoid colon is removed and the remaining rectum is reattached
• Delorme procedure: The prolapsed rectal tissue is removed and the remaining rectum is tightened

How effective is surgery for treating rectal prolapse?

Surgical treatment for rectal prolapse is generally very effective, with success rates ranging from 80% to 90% depending on the specific procedure. However, the choice of surgical approach depends on factors such as the patient’s age, overall health, and the extent of the prolapse. Your doctor will discuss the most appropriate option for your individual case.

Preventing Rectal Prolapse: Lifestyle Modifications

While not all cases of rectal prolapse can be prevented, certain lifestyle changes may help reduce the risk or prevent worsening of the condition:

• Maintain a healthy weight to reduce pressure on pelvic organs
• Eat a high-fiber diet and stay hydrated to promote regular bowel movements
• Avoid straining during bowel movements
• Practice pelvic floor exercises regularly, especially after pregnancy and childbirth
• Treat chronic coughs promptly
• Manage chronic constipation or diarrhea

How can pelvic floor exercises help prevent rectal prolapse?

Pelvic floor exercises, also known as Kegel exercises, can help strengthen the muscles that support the rectum and other pelvic organs. Regular practice of these exercises can improve muscle tone and function, potentially reducing the risk of rectal prolapse or helping to manage mild cases. To perform Kegel exercises:

1. Identify the correct muscles by stopping urination midstream
2. Tighten these muscles and hold for 5-10 seconds
3. Relax for 5-10 seconds
4. Repeat 10-15 times, 3 times a day

Rectal Prolapse and Pregnancy: Special Considerations

Pregnant women and new mothers should be particularly aware of the risk of rectal prolapse, given the increased strain on the pelvic floor during pregnancy and childbirth. Some important considerations include:

• Regular pelvic floor exercises during and after pregnancy
• Proper pushing techniques during labor to minimize strain on pelvic muscles
• Adequate postpartum recovery time before resuming strenuous activities
• Prompt treatment of constipation or other bowel issues

Can rectal prolapse affect future pregnancies?

If you have experienced rectal prolapse in the past, it’s important to discuss this with your healthcare provider when planning future pregnancies. While having a history of rectal prolapse doesn’t necessarily prevent you from having more children, it may increase the risk of recurrence. Your doctor can provide guidance on managing the condition during pregnancy and may recommend specific precautions or interventions to minimize complications.

Living with Rectal Prolapse: Coping Strategies and Support

Dealing with rectal prolapse can be challenging, both physically and emotionally. Here are some strategies to help cope with the condition:

• Seek support from family, friends, or support groups
• Maintain open communication with your healthcare provider
• Practice good hygiene to prevent irritation and infection
• Use a supportive device like a pessary if recommended by your doctor
• Consider counseling if the condition is affecting your mental health or relationships

Are there any over-the-counter products that can help manage rectal prolapse symptoms?

While there are no specific over-the-counter products designed to treat rectal prolapse, some items may help manage symptoms and improve comfort:

• Sitz baths to soothe irritated tissue
• Witch hazel pads to reduce inflammation
• Barrier creams to protect sensitive skin
• Stool softeners to ease bowel movements

Always consult with your healthcare provider before using any new products to manage your symptoms.

When to Seek Emergency Medical Care for Rectal Prolapse

While rectal prolapse is generally not a medical emergency, there are situations where immediate medical attention is necessary:

• Severe pain or bleeding associated with the prolapse
• Inability to reduce (push back) a prolapsed rectum
• Signs of infection, such as fever or unusual discharge
• Sudden worsening of symptoms or new, severe symptoms

What should you do if you can’t reduce a prolapsed rectum at home?

If you are unable to gently push the prolapsed rectum back into place, it’s important to seek medical help promptly. In the meantime:

1. Keep the prolapsed tissue clean and moist
2. Apply a cold compress to reduce swelling
3. Avoid straining or any activities that increase abdominal pressure
4. Lie down with your hips elevated to use gravity to your advantage

Remember, a healthcare professional can safely reduce the prolapse and provide appropriate treatment to prevent further complications.

A Complete Guide to Rectal Prolapse for Women

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Pregnancy + Postpartum

Oct 04, 2022Mattie Schuler4 MIN

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If you’ve had kids, we probably don’t have to tell you that hemorrhoids are a common indignity after pregnancy and childbirth. Superficial veins in the lower part of your rectum and anus can swell from the pressure of carrying a fetus and the strain of vaginal labor. These swollen veins can protrude and cause bulging of the sensitive skin around the anus after you poop leading to anal pain, itching, or bleeding.

But what if what protrudes is more than just a bit of tissue? What if things feel more off further inside? It might be something called rectal prolapse.

Read on for information about rectal prolapse, why it occurs, and how you can fix this extremely uncomfortable issue from the — ahem — bottom up.  

Your rectum is the final segment of your intestine. It’s sometimes referred to as the “rectal vault” because it’s where you store your poop before you…well…poop.  

“The rectum sits on top of layers of pelvic floor muscles,” says Ashley Rawlins, a physical therapist specializing in pelvic health and obstetric health. “Along with your pelvic floor muscles, the anus is the ring of muscular tissue that helps hold the poop inside until you’re ready on the toilet.” When the muscles and attachments that support the rectum and hold it in place inside your body become overstretched or weakened over time, your rectum can slip down along with your poop, turning it “inside out.”

When your rectum — or any organ — falls out of place, it’s called a prolapse. There are three different types of rectal prolapse, based on how severe it is:

• Internal prolapse, also known as an intussusception, is when your rectum telescopes into itself but stays inside your body.  
• ‍Partial prolapse is when some of your rectal tissue bulges outside of your anus. 
• ‍Complete, or external, prolapse is just what it sounds like: The whole rectum comes out. 

A prolapse may occur only when you’re pooping or, over time, it may become constant.

Rectal prolapse is fairly uncommon — it only occurs in 0.25% of people overall — but it does happen, and having kids raises your risks. One study noted that rectal prolapse is most frequently seen in women over 50 who have had more than one child.  

The main risk factors for rectal prolapse include:

• Injured anus or pelvic floor muscles from something like pregnancy and childbirth or nerve damage from surgery in that area 
• Vaginal tears during birth
• If you’ve been a life-long, prolonged strainer when it comes to pooping
• Chronic constipation or diarrhea
• Chronic cough, like with COPD
• Aging and menopause, which can lead to deterioration of collagen structures that support all of our tissues

Overall, being pregnant is one of the top risk factors for prolapse. That’s not surprising, says Rawlins, considering “all of those huge changes that we go through during pregnancy, including the softening of the ligaments and support structures throughout the body, and the added weight of the fetus.” 

Add in childbirth and there’s even more potential for injury that you could sustain. Rawlins notes that surgically assisted vaginal births — those that use forceps or vacuum assistance — place even more stress on the body and can cause damage to your pelvic floor support. 

Some symptoms of rectal prolapse are subtle, like pressure or bulging in your anus, or the feeling of pelvic heaviness after you poop, says Rawlins. You might experience pain, itching, or bleeding, like with hemorrhoids.

Fecal incontinence, or leakage of mucus or poop, can also occur, which can feel like something is dripping down and out of your anus (similar to the feeling of a tampon falling out) — or like something is there, but you just can’t clear it.  

A full rectal prolapse is definitely more noticeable and can sometimes be painful. “It can look like your insides coming out,” says Rawlins, “with the walls of the rectum protruding through, like pink rings of tissue that look swollen or engorged.” 

These signs of prolapse can be scary. If they happen to you, you might be worried that you’re literally falling apart. You aren’t! Rectal prolapse is very treatable and your body will get back to normal. See a doctor as soon as possible and, in the meantime, there are a few things you can do to take care of yourself and feel a bit more at ease:

• With clean hands, you may be able to gently move the tissue back inside of your body
• The mucosal tissue of the rectum is sensitive and may be too tender to be wiped with rough tissue paper after bowel movements. Instead, try cleansing your perineal area with a bidet or peri bottle — a plastic squeeze bottle with a nozzle that’s typically given to postpartum patients to use as they heal from childbirth.
• Lay down on your back with your feet up the wall or the headboard of your bed. In this position, gravity will literally unweight the entire lower half of your body and encourage the prolapsed tissue to move back into place. Use this position as often as you need to reduce prolapse-related discomfort.
• Pelvic support belts, worn over soft underwear or pants, can add support to heavy pelvic tissues to provide relief. The Femme Jock for example, provides good support from tailbone to pubic bone.

It’s easy to get these two conditions confused. With both a rectal prolapse and a prolapsed hemorrhoid, tissue from inside of the rectum is coming out of the body.

Here’s the difference: A prolapsed hemorrhoid is formed when veins inside the rectum dilate and swell to the point where swollen tissue begins to protrude outside of the anus. With rectal prolapse, the tissue that’s protruding out of the anus is part of the weakened rectal wall.

Not sure which you have? With rectal prolapse, you’re likely to have accompanying symptoms like fecal incontinence (bowel leaks) or a sense of heaviness or fullness in your bowels. The protruding tissue of a rectal prolapse will also look different from the swollen red mass of a hemorrhoid. With rectal prolapse, you can often see the concentric circles characteristic of the rectum. A prolapsed hemorrhoid will also become harder and more painful as it advances.

Unlike hemorrhoids, rectal prolapse is unlikely to get better on its own — and it can actually get worse over time. If your case is more severe, like a complete prolapse, your doctor might recommend surgery as the best first option. 

For less severe cases, pelvic floor physical therapy can help by:

• improving muscular support 
• strengthening the endurance of the pelvic floor muscles
• working on timing anal contractions to prevent leakage
• coordination training to prevent straining and encourage relaxing and opening the pelvic floor muscles when pushing

A pelvic floor physical therapist can also help by checking if your pelvic floor muscles are too tight, too weak to support the rectum, or if you have coordination and timing issues. They can also help to assess the health of the nerves in the area, which help the muscles work properly, and even assist in early sensing of rectal contents to help prevent leakage. If you’ve had holding patterns in the past when it comes to needing to poop, your “drive” to poop might have lessened over time. In a chronically constipated person, the bowel tends to be like a “slightly deflated balloon that doesn’t have as much stretch sensitivity,” Rawlins says. “So it’s not really telling your brain anymore that your body needs to go.” 

A pelvic floor physical therapist will also devote time to answering all of your questions and supporting you as you go through the process of healing. They act as an expert in your corner, making sure you have all the knowledge and tools that you need.

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What if chronic straining on the toilet is contributing to, or worsening, rectal prolapse after your pregnancy or birth?

You’ve got to start with proper bowel care. “Look at your diet, your hydration, your pooping habits,” says Rawlins. “All these things can really help optimize your bowel health in general, especially with less severe cases where tissues aren’t significantly prolapsed.” Doctors might recommend over-the-counter or prescribed stool softeners if bulky stool is contributing to the straining behaviors. 

Want to keep your bowels happy? Start here:

• Eat meals at regularly scheduled times
• Eat foods high in fiber, like beans, whole grains, and fruits and veggies, especially leafy greens
• Stay hydrated to balance out your fiber intake
• Get active: Moving your body moves your bowels 
• Learn about bowel or abdominal massage to stimulate the bowels

Since prolapse tends to get worse over time, sitting on your symptoms is never a good idea. If you think you have any sort of rectal prolapse, get help as soon as possible. See your healthcare provider for an assessment and ask if a referral to physical therapy is right for you. You deserve to feel good in your body and poop without pain or discomfort. We’re here to help!

Mattie Schuler

Mattie Schuler is a freelance writer specializing in health and wellness, outdoor adventure and gear, travel, education, and parenting. When she isn’t writing, she’s actively looking for dogs to pet, wrangling children in the wilderness (she’s also a forest school teacher in Boulder, Colorado), and either tracking snow reports or international flights, depending on the season. Her work has appeared in many publications, including Women’s Health, Gear Junkie, and Outside.

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Rectal Prolapse | Michigan Medicine

Rectal prolapse is a condition in which the inside of the rectum turns inside out and comes out of the anus with bowel movements or sometimes spontaneously. It can be brought on by straining hard and frequently trying to move your bowels. It can also happen when you lose tone or function in the muscles that hold the rectum in place. Rectal prolapse may occur in men or women, but it is more common in women.

There are two grades of rectal prolapse:

• Partial prolapse – The lining of the rectum protrudes when you strain to have a bowel movement. Sometimes it is hard to tell the difference between this and prolapsed internal hemorrhoids, which are much more common.
• Complete prolapse (or procidentia) – The sleeve of the rectum turns inside out and protrudes from the anus. This may occur during bowel movements. It may occur walking or standing. It can be “reduced” or put back where it belongs by standing and tightening the pelvic muscles or by manually pushing it back inside. Rarely, the prolapsed rectal tissue may remain outside the body all the time.

Causes of Rectal Prolapse

The rectum is normally suspended or held in place by pelvic muscles that create an angle between the rectum and the anal canal. For rectal prolapse to occur, there must be loss of pelvic muscle tone and loosening of the other tissues that normally tether the rectum in place. A life-long habit of straining to have bowel movements can lead to this weakness, as can the stresses involved in childbirth. Some neurologic disorders (loss of nerve supply) can lead to weakening of the pelvic and anal sphincter muscles. In rare cases, there may be a hereditary predisposition. In some cases, no single cause can be identified.

Symptoms of Rectal Prolapse

Symptoms of rectal prolapse may include:

• Tissue protruding from the rectum after bowel movements or exercise
• Leakage of stool or incontinence of stool
• Not being able to feel when you are about to have a bowel movement
• A feeling of having full bowels and an urgent need to have a bowel movement
• Passage of many very small stools
• The feeling of not being able to empty the bowels completely

Rectal Prolapse Treatment

The first line of treatment is aimed at preventing constipation and avoiding straining to have a bowel movement. A diet rich in fiber (25–35 grams per day) along with 6–8 glasses of decaffeinated fluids every day will assist in keeping stools soft. Physical therapy can also help strengthen weakened muscles and improve pelvic muscle tone to make the pelvic floor stronger. If prolapse can be reduced easily and does not occur spontaneously, no special additional treatment is needed. However, if this is not the case and conservative measures have failed, surgical consultation is warranted.

There are two basic types of operation for rectal prolapse: one requiring an abdominal approach and one that is done through the rectum. The abdominal approach usually involves resecting or removing the redundant part of the bowel that is coming out (resection) and tacking the rectum up on the inside so it can’t come out again (rectopexy). We believe that repairs using permanent mesh should be avoided because of their potential for long-term complications. Resection and rectopexy give the best long-term results and lowest recurrence rates.

An alternative approach is to remove the prolapsing bowel through the rectum. This is appropriate for patients who are in poor health and cannot tolerate an abdominal operation. It is usually well tolerated but has a higher long-term recurrence rate.

Surgery is most successful for people who still have some control over their bowel movements. If the anal sphincter is already weak or damaged, surgery may correct the prolapse but not correct the fecal incontinence (lack of control of bowel movements) that usually accompanies prolapse. It is important to have strong muscles of the pelvic floor. It may be recommended to have a course of physical therapy before surgery.

In some situations, if incontinence is severe, it may be necessary to do a diverting colostomy, so that the bowels no longer move through the rectum.

Additional Resources

• How to Reduce your Rectal Prolapse
• High Fiber Diet
• Food, Fiber, Fluid and Bowel Diary
• Healthy Bowel Habits

Make an Appointment

To schedule an appointment or learn more, call the Michigan Bowel Control Program at 734-763-6295.

Rectal prolapse – causes, symptoms and treatment

Rectal prolapse (rectal prolapse, pelvic floor prolapse)

Rectal prolapse is a condition where the rectum or part of it loses its proper position inside the body, becomes mobile, stretches and exits through the anus. Prolapse of the rectum is divided into two types: internal (hidden) and external. The internal prolapse of the rectum differs from the external one in that the rectum has already lost its position, but has not yet come out. Prolapse of the rectum is often accompanied by weakness of the muscles of the anal canal, which entails the incontinence of gases, feces and mucus.

In women, the main factors in the development of rectal prolapse are pregnancy and childbirth. The prerequisites for the onset of the disease in men may be regular physical activity or the habit of strong straining.

Prolapse of the rectum usually does not cause pain at the very beginning of the disease. The main problems with rectal prolapse for patients are the feeling of discomfort and a foreign body in the anus, as well as an unaesthetic appearance, which significantly impairs the quality of human life.

Rectal prolapse usually responds well to treatment and has a low recurrence rate (recurrence) of only about 15%. Complications in treatment usually occur when the patient seeks specialized help late and tries to self-diagnose and treat. As a result of these actions – lost time for success in treatment. If no treatment is taken, part of the prolapsed intestine will gradually increase, in addition, the anal sphincter will stretch, and the likelihood of damage to the pelvic nerves will also increase. All this entails the following complications:0007

• Ulcers of the mucous membrane of the rectum.
• Tissue necrosis (necrosis) of the rectal wall.
• Bleeding.
• Incontinence of gases, mucus and feces.

The length of time during which these changes occur varies widely and differs from person to person, no physician can give an exact time frame for these serious disturbances to occur.

Normal

Dropout

Rectal prolapse and hemorrhoids

One of the common reasons why a patient does not see a doctor immediately after a problem occurs is the outward similarity of the manifestation of the disease with hemorrhoids, which they try to cure on their own – with suppositories and ointments. In fact, rectal prolapse and hemorrhoids are completely different diseases that outwardly may indeed seem similar due to the flow of tissue from the anal canal. Only with hemorrhoids, hemorrhoidal tissue falls out, and with rectal prolapse, part of the rectum. Also, both diseases have some similar symptoms, such as bleeding.

It is important to remember that incorrect diagnosis and incorrect treatment will never lead to the expected positive effect, and in some cases will exacerbate the problem.

Causes of the disease

What is the cause of rectal prolapse?

• Anything that increases pressure inside the abdomen can cause rectal prolapse. Constipation, diarrhea, prostatic hyperplasia (straining when urinating), pregnancy and childbirth, persistent cough.
• Injury to the anus, pelvic floor muscles, spinal nerves, pelvic nerves from previous surgery or trauma.
• Infections of the intestines with certain types of germs called parasites (such as amoebiasis and schistosomiasis).
• Certain disorders of the nervous system, such as multiple sclerosis.
• Mental health conditions associated with constipation such as: depression, anxiety, a side effect of medications used to treat mental disorders.

Symptoms of rectal prolapse

• The most common symptom that should alert you is the feeling of a foreign body in the anus coming out of the anus. In the early stages, this may occur during straining, but as the condition progresses, it may occur when coughing, sneezing, standing up, walking.
  In the early stages, when the prolapse is relatively minor, manual manipulation (fingering the bowel inward) will be successful, but over time this will become impossible.
• Sensation of incomplete emptying of the bowels – usually occurs in case of latent (internal) prolapse of the rectum.
• Fecal incontinence resulting in soiled clothing. Incontinence of gas, loose and hard stools, or mucus/blood discharge may also occur.
• Constipation occurs in up to 30-50% of patients with rectal prolapse. Constipation can occur due to congestion of the rectum, creating a blockage that gets worse with exertion.
• Pain and discomfort in the anus.
• Bleeding – Over time, the prolapsed mucosa can become thick and ulcerated, causing bleeding.

Diagnosis

In most cases, an experienced doctor will be able to make a diagnosis at the initial examination. However, there are additional research methods to assess the severity of the disease and help in the correct choice of one or another method of treatment.

Tests that may be required to determine the severity of rectal prolapse:

• Anal electromyography. This test determines if nerve damage is causing the anal sphincters to not work properly. It also deals with the coordination of the rectum and anal muscles.
• Anal manometry. This test examines the strength of the anal sphincter muscles. The study allows you to evaluate the function of holding.
• Transrectal ultrasound. E This test helps evaluate the shape and structure of the anal sphincter muscles and surrounding tissues.
• Proctography (defecography). This test evaluates how well the rectum holds stool and how well the rectum empties.
• Colonoscopy. Allows you to visually inspect the entire colon and helps identify any problems.

Our Clinic has all the necessary diagnostic services. We also work closely with urologists and gynecologists from other departments of Sechenov University, which allows us to approach the issue of treating rectal prolapse in a multidisciplinary manner, that is, jointly.

Treatment of rectal prolapse

In our Clinic, the whole spectrum of treatment of rectal prolapse is performed. Based on the stage of the disease and its manifestations, our specialists select the most optimal method of treatment. It is important to understand that rectal prolapse is a complex disease, the treatment of which is impossible without surgical intervention. For the treatment of rectal prolapse, our Clinic uses the following surgical techniques:

Abdominal operations (operations through the abdominal cavity)

1. The operation of rectosacropexy – for it, a mesh allograft (alloprosthesis) is used, which holds the intestine in a given position. During the operation, the rectum is mobilized to the level of the muscles that lift the anus, then the rectum is pulled up and fixed to the presacral fascia, located between the sacrum and the rectum, using a mesh allograft.

2. Kümmel’s operation is the fixation of the previously mobilized rectum to the promontory of the sacrum with interrupted sutures.

These operations can be performed either openly through incisions (laparotomy) or laparoscopically through small incisions.

Transanal operations (operations through the anal canal)

1. Delorme operation is the removal (resection) of the mucous membrane of the prolapsed part of the intestine with the formation of a muscular cuff that holds the intestine, protecting it from prolapse.

2. Altmeer operation — resection of the rectum or its prolapsed area with the formation of a colonanal anastomosis – attachment of the colon to the anal canal.

Surgical treatment in most cases allows patients to completely get rid of the symptoms of rectal prolapse. The success of treatment depends on the type of prolapse – internal or external, on the general condition of the patient and on the degree of neglect of the disease. Patients may need some time to restore the functions of the gastrointestinal tract. After the operation, it is important to control the stool, avoid constipation and severe straining.

Rectal prolapse – methods of treatment, stages of prolapsed nodes, 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;
• injury to 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.

Experts also distinguish two types of rectal prolapse:

• Hernial – the Douglas pocket and the anterior wall of the rectum are displaced downward, 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 inserted into 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.

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

• sensation of a foreign body in the anus;
• pain in the abdomen that increases during walking, exercise, defecation;
• incontinence, inability to hold back gases, feces;
• frequent false urge to defecate;
• sensation of incomplete bowel movements;
• frequent urination;
• secretion of mucus, blood from the anus;
• 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 bowel prolapse 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 prolapsed rectum;
• bowel fixation;
• anal canal, pelvic floor plasty;
• 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 painful 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

Ladozhskaya metro station

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Aramyan David Surenovich

Surgeon, coloproctologist, oncologist, mammologist

Work experience: 1 3 years

Malaya Balkanskaya, 23

m. Kupchino

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Yaroslav Viktorovich Kolosovsky

Surgeon, mammologist, oncologist

Work experience: 17 years

Dybenko, 13k4

m. Dybenko Street

9000 4 Make an appointment

Karapetyan Zaven Surenovich

Coloproctologist, surgeon and phlebologist

Work experience: 15 years 0

Leninsky Prospect metro station

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Shishkin Andrey Andreevich

Surgeon, phlebologist, proctologist. Candidate of Medical Sciences

Work experience: 13 years

Danaisky, 47

Dunayskaya metro station

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Maslennikov Dmitry Yurievich

Surgeon, proctologist, mammologist

Work experience: 16 years

Udarnikov, 19

Ladozhskaya metro station

Dybenko, 13k4

Dy Street metro station benko

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+15 doctors

Other doctors 15 doctors

Ardashov Pavel Sergeevich

Coloproctologist-surgeon

Work experience: 9 years

Udarnikov, 19

Ladozhskaya metro station

Dybenko, 13k4

m. Dybenko street

Make an appointment

Bulkina Maria Sergeevna

Coloproctologist, surgeon

Work experience: 11 years specter of Enlightenment

Make an appointment

Grinevich Vladimir Stanislavovich

Surgeon, oncologist, mammologist, coloproctologist

Work experience: 27 years

Vyborgskoe highway, 17

metro Prosveshcheniya

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Klyuev Andrey Nikolaevich

Operating proctologist

Work experience: 16 years

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment

Nekrasov Roman Alexandrovich

Coloproctologist and surgeon

Work experience: 8 years

Udarnikov, 19

Ladozhskaya 9 metro station0007

Marshala Zakharov, 20

Leninsky Prospect metro station

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Petrova Vitalina Vasilievna

Operating proctologist

Work experience: 12 years

Vyborgskoe shosse, 17

metro station Prosveshcheniya

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Senko Vladimir Vladimirovich

Head of the Center for Surgery and Oncology

Work experience: 23 years

Dunaisky, 47

Dunayskaya metro station

Marshala Zakharova, 20

Leninskiy pr-t metro station

Vyborgskoye shosse, 17

Prosveshcheniya metro station

Make an appointment 90 007
Sinyagina (Nazarova) Maria Andreevna

Surgeon, proctologist

Work experience: 8 years

Marshala Zakharova, 20

Leninsky Prospect metro station

Make an appointment

903 43
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

Vyborgskoe shosse, 17

metro Prosveshcheniya

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Fomenko Nikolay Alexandrovich

Surgeon, proctologist, oncologist

Work experience: 15 years

Marshal Zakharov, 20

Leninskiy Prospekt

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Khangireev Alexander Bakhytovich

Surgeon, oncologist, coloproctologist

Work experience: 13 years

Udarnikov, 19

004 Dunayskaya metro station

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Khokhlov Sergey Viktorovich

Surgeon, oncologist, coloproctologist

Work experience: 28 years

Vyborgskoe shosse, 17

metro Prospekt Prosveshcheniya

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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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