Protrusion of rectum: Treatment, Diagnosis, Causes & Symptoms

22.12.197515.10.2021 by alexxlab

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Treatment, Diagnosis, Causes & Symptoms

Overview

What is rectal prolapse?

Rectal prolapse occurs when the rectum (the last section of the large intestine) falls from its normal position within the pelvic area and sticks out through the anus. (The word “prolapse” means a falling down or slipping of a body part from its usual position.)

The term “rectal prolapse” can describe three types of prolapse:

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

Rectal prolapse is common in older adults who have a long-term history of constipation or a weakness in the pelvic floor muscles. It is more common in women than in men, and even more common in women over the age of 50 (postmenopausal women), but occurs in younger people too. Rectal prolapse can also occur in infants – which could be a sign of cystic fibrosis – and in older children.

Is rectal prolapse just another name for hemorrhoids?

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

Symptoms and Causes

What causes rectal prolapse?

Rectal prolapse can occur as a result of many conditions, including:

Chronic (long-term) constipation or chronic diarrhea
Long-term history of straining during bowel movements
Older age: Muscles and ligaments in the rectum and anus naturally weaken with age. Other nearby structures in the pelvis area also loosen with age, which adds to the general weakness in that area of the body.
Weakening of the anal sphincter: This is the specific muscle that controls the release of stool from the rectum.
Earlier injury to the anal or pelvic areas
Damage to nerves: If the nerves that control the ability of the rectum and anus muscles to contract (shrink) are damaged, rectal prolapse can result. Nerve damage can be caused by pregnancy, difficult vaginal childbirth, anal sphincter paralysis, spinal injury, back injury/back surgery and/or other surgeries of the pelvic area.
Other diseases, conditions and infections: Rectal prolapse can be a consequence of diabetes, cystic fibrosis, chronic obstructive pulmonary disease, hysterectomy, and infections in the intestines caused by parasites – such as pinworms and whipworms – and diseases resulting from poor nutrition or from difficulty digesting foods.

What are the symptoms of rectal prolapse?

The symptoms of rectal prolapse include the feeling of a bulge or the appearance of reddish-colored mass that extends outside the anus. At first, this can occur during or after bowel movements and is a temporary condition. However, over time – because of an ordinary amount of standing and walking – the end of the rectum may even extend out of the anal canal spontaneously, and may need to be pushed back up into the anus by hand.

Other symptoms of rectal prolapse include pain in the anus and rectum and bleeding from the inner lining of the rectum. These are rarely life-threatening symptoms.

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

Diagnosis and Tests

How is rectal prolapse diagnosed?

First, your doctor will take your medical history and will perform a rectal exam. You may be asked to “strain” while sitting on a commode to mimic an actual bowel movement. Being able to see the prolapse helps your doctor confirm the diagnosis and plan treatment.

Other conditions, such as urinary incontinence, bladder prolapse and vaginal/uterine prolapse, could be present along with rectal prolapse. Because of the variety of potential problems, urologists, urogynecologists and other specialists often team together to share evaluations and make joint treatment decisions. In this way, surgeries to repair any combination of these problems can be done at the same time.

Doctors can use several tests to diagnose rectal prolapse and other pelvic floor problems, and to help determine the best treatment for you. Tests used to evaluate and make treatment decisions include:

Anal electromyography (EMG): This test determines if nerve damage is the reason why the anal sphincters are not working properly. It also examines the coordination between the rectum and anal muscles.
Anal manometry: This test studies the strength of the anal sphincter muscles. A short, thin tube, inserted up into the anus and rectum, is used to measure the sphincter tightness.
Anal ultrasound: This test helps evaluate the shape and structure of the anal sphincter muscles and surrounding tissue. In this test, a small probe is inserted up into the anus and rectum to take images of the sphincters.
Pudendal nerve terminal motor latency test: This test measures the function of the pudendal nerves, which are involved in bowel control.
Proctography (also called defecography): This test is done in the radiology department. In this test, an X-ray video is taken that shows how well the rectum is functioning. The video shows how much stool the rectum can hold, how well the rectum holds the stool, and how well the rectum releases the stool.
Colonoscopy: This is an exam of the colon or large bowel. A flexible tube with a camera is passed through the anus upwards to where the large intestine joins the small intestine. This helps provide visual clues as to the source of the problem.
Proctosigmoidoscopy: This test allows the lining of the lower portion of the colon to be viewed, looking for any abnormalities such as inflammation, tumor or scar tissue. To perform this test, a flexible tube with a camera attached to the end is inserted into the rectum up to the sigmoid colon.
Magnetic resonance imaging (MRI): This test is done in the radiology department. It is sometimes used to evaluate the pelvic organs.

Management and Treatment

How is rectal prolapse treated?

In some cases of very minor, early prolapse, treatment can begin at home with the use of stool softeners and by pushing the fallen tissue back up into the anus by hand. However, surgery is usually necessary to repair the prolapse.

There are several surgical approaches. The surgeon’s choice depends on patient’s age, other existing health problems, the extent of the prolapse, results of the exam and other tests and the surgeon’s preference and experience with certain techniques.

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

Abdominal repair approaches

Abdominal procedure refers to making an incision in the abdominal muscles to view and operate in the abdominal cavity. It is usually performed under general anesthesia and is the approach most often used in healthy adults.

The two most common types of abdominal repair are rectopexy (fixation [reattachment] of the rectum) and resection (removal of a segment of intestine) followed by rectopexy. Resection is preferred for patients who have severe constipation. Rectopexy can also be performed laparoscopically through small keyhole incisions, or robotically, making recovery much easier for patients.

Rectal (perineal) repair approaches

Rectal procedures are often used in older patients and in patients who have more medical problems. Spinal anesthesia or an epidural (anesthesia that blocks pain in a certain part of the body) may be used instead of general anesthesia in these patients. The two most common rectal approaches are the Altemeier and Delorme procedures:

Altemeier procedure: In this procedure — also called a perineal proctosigmoidectomy — the portion of the rectum extending out of the anus is cut off (amputated) and the two ends are sewn back together. The remaining structures that help support the rectum are stitched back together in an attempt to provide better support.
Delorme procedure: In this procedure, only the inner lining of the fallen rectum is removed. The outer layer is then folded and stitched and the cut edges of the inner lining are stitched together so that rectum is now inside the anal canal.

What are the risks/complications that may occur after rectal prolapse surgery?

As with any surgery, anesthesia complications, bleeding and infection are always risks. Other risks and complications from surgeries to repair rectal prolapse include:

Lack of healing where the two ends of bowel reconnect. This can happen in a surgery in which a segment of the bowel is removed and the two ends of the remaining bowel are reconnected.
Intra-abdominal or rectal bleeding
Urinary retention (inability to pass urine)
Medical complications of surgery: heart attack, pneumonia, deep venous thrombosis (blood clots)
Return of the rectal prolapse
Worsening or development fecal incontinence
Worsening or development of constipation

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

Outlook / Prognosis

How successful is rectal prolapse surgery?

Success can vary depending on the condition of supporting tissues and the age and health of the patient. Abdominal procedures are associated with a lower chance of the prolapse coming back, compared with perineal procedures. However, in most patients, surgery fixes the prolapse.

How long is recovery from rectal prolapse surgery?

The average length of hospital stay is 2 to 3 days, but this varies depending on a patient’s other health conditions. Complete recovery can usually be expected in a month; however, patients should avoid straining and heavy lifting for at least 6 months. In fact, the best chance for preventing prolapse from returning is to make a lifetime effort to avoid straining and any activities that increase abdominal pressure.

Treatment, Diagnosis, Causes & Symptoms

Overview

What is rectal prolapse?

The term “rectal prolapse” can describe three types of prolapse:

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

Is rectal prolapse just another name for hemorrhoids?

Symptoms and Causes

What causes rectal prolapse?

Rectal prolapse can occur as a result of many conditions, including:

Chronic (long-term) constipation or chronic diarrhea
Long-term history of straining during bowel movements
Older age: Muscles and ligaments in the rectum and anus naturally weaken with age. Other nearby structures in the pelvis area also loosen with age, which adds to the general weakness in that area of the body.
Weakening of the anal sphincter: This is the specific muscle that controls the release of stool from the rectum.
Earlier injury to the anal or pelvic areas
Damage to nerves: If the nerves that control the ability of the rectum and anus muscles to contract (shrink) are damaged, rectal prolapse can result. Nerve damage can be caused by pregnancy, difficult vaginal childbirth, anal sphincter paralysis, spinal injury, back injury/back surgery and/or other surgeries of the pelvic area.
Other diseases, conditions and infections: Rectal prolapse can be a consequence of diabetes, cystic fibrosis, chronic obstructive pulmonary disease, hysterectomy, and infections in the intestines caused by parasites – such as pinworms and whipworms – and diseases resulting from poor nutrition or from difficulty digesting foods.

What are the symptoms of rectal prolapse?

Other symptoms of rectal prolapse include pain in the anus and rectum and bleeding from the inner lining of the rectum. These are rarely life-threatening symptoms.

Diagnosis and Tests

How is rectal prolapse diagnosed?

Anal electromyography (EMG): This test determines if nerve damage is the reason why the anal sphincters are not working properly. It also examines the coordination between the rectum and anal muscles.
Anal manometry: This test studies the strength of the anal sphincter muscles. A short, thin tube, inserted up into the anus and rectum, is used to measure the sphincter tightness.
Anal ultrasound: This test helps evaluate the shape and structure of the anal sphincter muscles and surrounding tissue. In this test, a small probe is inserted up into the anus and rectum to take images of the sphincters.
Pudendal nerve terminal motor latency test: This test measures the function of the pudendal nerves, which are involved in bowel control.
Proctography (also called defecography): This test is done in the radiology department. In this test, an X-ray video is taken that shows how well the rectum is functioning. The video shows how much stool the rectum can hold, how well the rectum holds the stool, and how well the rectum releases the stool.
Colonoscopy: This is an exam of the colon or large bowel. A flexible tube with a camera is passed through the anus upwards to where the large intestine joins the small intestine. This helps provide visual clues as to the source of the problem.
Proctosigmoidoscopy: This test allows the lining of the lower portion of the colon to be viewed, looking for any abnormalities such as inflammation, tumor or scar tissue. To perform this test, a flexible tube with a camera attached to the end is inserted into the rectum up to the sigmoid colon.
Magnetic resonance imaging (MRI): This test is done in the radiology department. It is sometimes used to evaluate the pelvic organs.

Management and Treatment

How is rectal prolapse treated?

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

Abdominal repair approaches

Rectal (perineal) repair approaches

Altemeier procedure: In this procedure — also called a perineal proctosigmoidectomy — the portion of the rectum extending out of the anus is cut off (amputated) and the two ends are sewn back together. The remaining structures that help support the rectum are stitched back together in an attempt to provide better support.
Delorme procedure: In this procedure, only the inner lining of the fallen rectum is removed. The outer layer is then folded and stitched and the cut edges of the inner lining are stitched together so that rectum is now inside the anal canal.

What are the risks/complications that may occur after rectal prolapse surgery?

As with any surgery, anesthesia complications, bleeding and infection are always risks. Other risks and complications from surgeries to repair rectal prolapse include:

Lack of healing where the two ends of bowel reconnect. This can happen in a surgery in which a segment of the bowel is removed and the two ends of the remaining bowel are reconnected.
Intra-abdominal or rectal bleeding
Urinary retention (inability to pass urine)
Medical complications of surgery: heart attack, pneumonia, deep venous thrombosis (blood clots)
Return of the rectal prolapse
Worsening or development fecal incontinence
Worsening or development of constipation

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

Outlook / Prognosis

How successful is rectal prolapse surgery?

How long is recovery from rectal prolapse surgery?

Treatment, Diagnosis, Causes & Symptoms

Overview

What is rectal prolapse?

The term “rectal prolapse” can describe three types of prolapse:

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

Is rectal prolapse just another name for hemorrhoids?

Symptoms and Causes

What causes rectal prolapse?

Rectal prolapse can occur as a result of many conditions, including:

Chronic (long-term) constipation or chronic diarrhea
Long-term history of straining during bowel movements
Older age: Muscles and ligaments in the rectum and anus naturally weaken with age. Other nearby structures in the pelvis area also loosen with age, which adds to the general weakness in that area of the body.
Weakening of the anal sphincter: This is the specific muscle that controls the release of stool from the rectum.
Earlier injury to the anal or pelvic areas
Damage to nerves: If the nerves that control the ability of the rectum and anus muscles to contract (shrink) are damaged, rectal prolapse can result. Nerve damage can be caused by pregnancy, difficult vaginal childbirth, anal sphincter paralysis, spinal injury, back injury/back surgery and/or other surgeries of the pelvic area.
Other diseases, conditions and infections: Rectal prolapse can be a consequence of diabetes, cystic fibrosis, chronic obstructive pulmonary disease, hysterectomy, and infections in the intestines caused by parasites – such as pinworms and whipworms – and diseases resulting from poor nutrition or from difficulty digesting foods.

What are the symptoms of rectal prolapse?

Other symptoms of rectal prolapse include pain in the anus and rectum and bleeding from the inner lining of the rectum. These are rarely life-threatening symptoms.

Diagnosis and Tests

How is rectal prolapse diagnosed?

Anal electromyography (EMG): This test determines if nerve damage is the reason why the anal sphincters are not working properly. It also examines the coordination between the rectum and anal muscles.
Anal manometry: This test studies the strength of the anal sphincter muscles. A short, thin tube, inserted up into the anus and rectum, is used to measure the sphincter tightness.
Anal ultrasound: This test helps evaluate the shape and structure of the anal sphincter muscles and surrounding tissue. In this test, a small probe is inserted up into the anus and rectum to take images of the sphincters.
Pudendal nerve terminal motor latency test: This test measures the function of the pudendal nerves, which are involved in bowel control.
Proctography (also called defecography): This test is done in the radiology department. In this test, an X-ray video is taken that shows how well the rectum is functioning. The video shows how much stool the rectum can hold, how well the rectum holds the stool, and how well the rectum releases the stool.
Colonoscopy: This is an exam of the colon or large bowel. A flexible tube with a camera is passed through the anus upwards to where the large intestine joins the small intestine. This helps provide visual clues as to the source of the problem.
Proctosigmoidoscopy: This test allows the lining of the lower portion of the colon to be viewed, looking for any abnormalities such as inflammation, tumor or scar tissue. To perform this test, a flexible tube with a camera attached to the end is inserted into the rectum up to the sigmoid colon.
Magnetic resonance imaging (MRI): This test is done in the radiology department. It is sometimes used to evaluate the pelvic organs.

Management and Treatment

How is rectal prolapse treated?

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

Abdominal repair approaches

Rectal (perineal) repair approaches

Altemeier procedure: In this procedure — also called a perineal proctosigmoidectomy — the portion of the rectum extending out of the anus is cut off (amputated) and the two ends are sewn back together. The remaining structures that help support the rectum are stitched back together in an attempt to provide better support.
Delorme procedure: In this procedure, only the inner lining of the fallen rectum is removed. The outer layer is then folded and stitched and the cut edges of the inner lining are stitched together so that rectum is now inside the anal canal.

What are the risks/complications that may occur after rectal prolapse surgery?

As with any surgery, anesthesia complications, bleeding and infection are always risks. Other risks and complications from surgeries to repair rectal prolapse include:

Lack of healing where the two ends of bowel reconnect. This can happen in a surgery in which a segment of the bowel is removed and the two ends of the remaining bowel are reconnected.
Intra-abdominal or rectal bleeding
Urinary retention (inability to pass urine)
Medical complications of surgery: heart attack, pneumonia, deep venous thrombosis (blood clots)
Return of the rectal prolapse
Worsening or development fecal incontinence
Worsening or development of constipation

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

Outlook / Prognosis

How successful is rectal prolapse surgery?

How long is recovery from rectal prolapse surgery?

Rectal Prolapse | Michigan Medicine

Topic Overview

What is rectal prolapse?

Rectal prolapse occurs when part or all of the wall of the rectum slides out of place, sometimes sticking out of the anus. See a picture of rectal prolapse.

There are three types of rectal prolapse.

Partial prolapse (also called mucosal prolapse). The lining (mucous membrane) of the rectum slides out of place and usually sticks out of the anus. This can happen when you strain to have a bowel movement. Partial prolapse is most common in children younger than 2 years.
Complete prolapse. The entire wall of the rectum slides out of place and usually sticks out of the anus. At first, this may occur only during bowel movements. Eventually, it may occur when you stand or walk. And in some cases, the prolapsed tissue may remain outside your body all the time.
Internal prolapse (intussusception). One part of the wall of the large intestine (colon) or rectum may slide into or over another part, like the folding parts of a toy telescope. The rectum does not stick out of the anus. (See a picture of intussusception.) Intussusception is most common in children and rarely affects adults. In children, the cause is usually not known. In adults, it is usually related to another intestinal problem, such as a growth of tissue in the wall of the intestines (such as a polyp or tumor).

In severe cases of rectal prolapse, a section of the large intestine drops from its normal position as the tissues that hold it in place stretch. Typically there is a sharp bend where the rectum begins. With rectal prolapse, this bend and other curves in the rectum may straighten, making it difficult to keep stool from leaking out (fecal incontinence).

Rectal prolapse is most common in children and older adults, especially women.

What causes rectal prolapse?

Many things increase the chance of developing rectal prolapse. Risk factors for children include:

Cystic fibrosis. A child who has rectal prolapse with no obvious cause may need to be tested for cystic fibrosis.
Having had surgery on the anus as an infant.
Malnutrition.
Deformities or physical development problems.
Straining during bowel movements.
Infections.

Risk factors for adults include:

Straining during bowel movements because of constipation.
Tissue damage caused by surgery or childbirth.
Weakness of pelvic floor muscles that occurs naturally with age.

What are the symptoms?

The first symptoms of rectal prolapse may be:

Leakage of stool from the anus (fecal incontinence).
Leakage of mucus or blood from the anus (wet anus).

Other symptoms of rectal prolapse include:

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.
Anal pain, itching, irritation, and bleeding.
Bright red tissue that sticks out of the anus.

See a doctor if you or your child has symptoms of rectal prolapse. If it is not treated, you may have more problems. For example, the leaking stool could get worse, or the rectum could be damaged.

How is rectal prolapse diagnosed?

Your doctor will diagnose rectal prolapse by asking you questions about your symptoms and past medical problems and surgeries. He or she will also do a physical exam, which includes checking the rectum for loose tissue and to find out how strongly the anal sphincter contracts.

You may need tests to rule out other conditions. For example, you may need a sigmoidoscopy, a colonoscopy, or a barium enema to look for tumors, sores (ulcers), or abnormally narrow areas in the large intestine. Or a child may need a sweat test to check for cystic fibrosis if prolapse has occurred more than once or the cause is not clear.

How is it treated?

Prolapse in children tends to go away on its own. You can help keep the prolapse from coming back. If you can, push the prolapse into place as soon as it occurs. You can also have your child use a potty-training toilet so that he or she does not strain while having a bowel movement.

Sometimes children need treatment. For example, if the prolapse doesn’t go away on its own, an injection of medicine into the rectum may help. If the prolapse was caused by another condition, the child may need treatment for that condition.

Home treatment for adults may help treat the prolapse and may be tried before other types of treatments.

If your doctor says it’s okay, you can push the prolapse into place.
Avoid constipation. Drink plenty of water, and eat fruits, vegetables, and other foods that contain fiber. Changes in diet often are enough to improve or reverse a prolapse of the lining of the rectum (partial prolapse).
Do Kegel exercises to help strengthen the muscles of the pelvic area.
Don’t strain while having a bowel movement. Use a stool softener if you need to.

People who have a complete prolapse or who have a partial prolapse that doesn’t improve with a change in diet will need surgery. Surgery involves attaching the rectum to the muscles of the pelvic floor or the lower end of the spine (sacrum). Or surgery might involve removing a section of the large intestine that is no longer supported by the surrounding tissue. Both procedures may be done in the same surgery.

Rectal Prolapse in Children | Boston Children’s Hospital

What is rectal prolapse?

The rectum is the lower portion of the large intestine. Normally, it is attached to the pelvis with ligaments and muscles. Rectal prolapse occurs when the lining of a child’s rectum protrudes through the anus and outside the body. This can occur because the ligaments and muscles become weakened from problems including chronic constipation, chronic diarrhea or straining while going to the bathroom. Underlying conditions such as cystic fibrosis and Hirschsprung’s disease can also cause rectal prolapse.

What are the symptoms of rectal prolapse?

The main symptom of rectal prolapse is the protrusion of part or all of the rectum’s lining through your child’s anal sphincter. You may notice a dark red mass protruding from the anus, sometimes accompanied by blood or mucus, particularly when your child is straining. Rectal prolapse isn’t usually painful, but it can cause discomfort. Other symptoms may include:

fecal incontinence (leakage of stool from the anus)
feeling of fullness or of not being able to completely empty the bowels
anal itching or irritation

What causes rectal prolapse?

Rectal prolapse occurs when the muscles and ligaments that support the rectum become weakened. Certain factors can make your child more likely to experience rectal prolapse, including:

straining while going to the bathroom
chronic constipation
acute or chronic diarrhea
malnutrition
cystic fibrosis
neurological conditions such as tethered cord or spinal cord injury
Hirschsprung’s disease and other colorectal and pelvic malformations
anal penetration, such as from sexual abuse

How we care for rectal prolapse

Most children who experience mild rectal prolapse can be treated by their pediatrician and likely won’t have another one. But for kids who have frequent or severe prolapse, treatment by a specialist is often necessary. The skilled clinicians in the Colorectal and Pelvic Malformation Center at Boston Children’s Hospital see infants and children who experience rectal prolapse due to Hirschsprung’s disease and other chronic conditions.

Rectal Prolapse – StatPearls – NCBI Bookshelf

Continuing Education Activity

Rectal prolapse refers specifically to prolapse of some or all of the rectal mucosa through the external anal sphincter. In pediatric populations aged between infancy and age 4, rectal prolapse is usually a self-limiting condition, responding to conservative management. The highest incidence of rectal prolapse has been noted in the first year of life. However, children presenting after age 4 usually have a chronic condition predisposing them to have developed rectal prolapse. This activity reviews the cause, pathophysiology and presentation of rectal prolpase and highlights the role of the interprofessional team in its management.

Objectives:

Review the etiology of rectal prolapse.
Describe the evaluation of a patient with rectal prolapse.
Summarize the treatment options for rectal prolapse.
Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by rectal prolapse.

Access free multiple choice questions on this topic.

Introduction

Rectal prolapse refers specifically to prolapse of some or all of the rectal mucosa through the external anal sphincter. In pediatric populations aged between infancy and age 4, rectal prolapse is usually a self-limiting condition, responding to conservative management. The highest incidence of rectal prolapse has been noted in the first year of life.[1] However, children presenting after age 4 usually have a chronic condition predisposing them to have developed rectal prolapse.[2] In some cases, prolapse may persist indefinitely, requiring surgical intervention.[3]

Etiology

Pediatric populations are more likely to develop rectal prolapse due to several anatomic differences in early childhood. In children, the rectum follows a vertical course along the sacrum and coccyx and is also in a relatively lower position than the other pelvic organs. The rectum also has a rather redundant rectal mucosa which is attached to the underlying muscularis only loosely. Compared with adult populations, the sigmoid colon has more mobility, and the levator ani muscle offers relatively little support. Finally, Houston valves, which provide structural integrity in the rectum, have not yet fully developed in the majority of infants less than one year.[1]

Rectal prolapse is also caused by increased bowel motility, increased abdominal pressure, and certain congenital conditions, to be outlined below. Increased bowel motility occurs most secondarily to infectious diarrhea caused by amebiasis, giardiasis, trichuriasis, Salmonella, Shigella, and Escherichia coli 0157:H7. Ulcerative colitis and laxative abuse may also cause increases in bowel motility. Next, increased abdominal pressure may commonly be caused by chronic constipation, protracted coughing, excessive vomiting, or straining at urination because of outlet obstruction. Finally, congenital conditions such as cystic fibrosis, myelomeningocele, Hirschsprung disease, spina bifida, congenital hypothyroidism are more likely to develop rectal prolapse. Other causes include malnutrition and anatomic defects such as mucosal polyps or tumors and imperforate anus post repair.[1][4]

Epidemiology

In pediatric populations, rectal prolapse occurs equally in male and female patients.[1] The highest incidence occurs from ages 1 to 3.[5] The affliction is much more common in underdeveloped countries, with common causes including parasitic disease, malnutrition, and diarrheal illness. In the United States, constipation is the most common association.[1]

Pathophysiology

As noted above, rectal prolapse refers specifically to prolapse of some or all of the rectal mucosa through the external anal sphincter. There are 2 types of rectal prolapse: type 1 and type 2, also called false procidentia and true procidentia, respectively. Type 1, which is partial or mucosal prolapse, produces radial folds at the junction with the anal skin. This type is usually involves less than 2 cm of prolapse and only the mucosa is prolapsed. Type 2, or complete prolapse, is characterized by full-thickness extrusion of the rectal wall. Concentric folds are seen in the prolapse mucosa. This type of prolapse, which is similar to intussusception functionally, is further divided into first, second, and third degree prolapse. First-degree, type 2 prolapse protrudes greater than 5 cm from the anal verge and includes the mucocutaneous junction. Second-degree prolapse protrudes only 2 to 5 cm from the anal verge. Finally, third-degree prolapse or occult rectal prolapse is an internal process and thus does not protrude through the anal verge.[1][4]

History and Physical

In adolescents with rectal prolapse, symptoms include tenesmus, anorectal pain, and passage of blood and mucus. In children, rectal prolapse is typically brought to medical attention after being detected by the patient’s parents. A dark red mass with or without mucus and blood that protrudes from the rectum during straining is described, yet this is commonly spontaneously resolved by the time the patient presents. Prolapse is usually painless or associated with only mild discomfort. At the time of prolapse, decreased or absent rectal tone may be present on a digital rectal exam, but the tone is usually normal after a few hours.[1]

Evaluation

Diagnosis of rectal prolapse is most commonly made based on history and physical alone. As mentioned above, prolapse often resolves by the time the patient reaches medical attention, and thus the clinician must rely on history for diagnosis. Patients with constipation as the likely cause of their prolapse should receive contrast radiography of the colon and anorectal manometry.[6] When evaluating third-degree or occult rectal prolapse, colonoscopy or sigmoidoscopy often reveals erythematous granularity of the distal rectum, in addition to a polypoid white-topped mucosal lesion on the anterior rectal wall.[7] These tests may also help visualize rectal polyps or ulcers if present. Evaluation for associated pelvic floor anomalies and further characterization of prolapse may also per performed by fluoroscopic dynamic defecography or magnetic resonance imaging.[1]

Treatment / Management

Conservative management of rectal prolapse includes stool softeners and/or laxatives, avoidance of prolonged straining, and treatment of any predisposing underlying conditions. Compliance with bowel regimen is important because patients who have repeat instances of rectal prolapse may be less responsive to rectal prolapse in the future. Generally, these conservative tools work for about 90% of patients who develop rectal prolapse before age 3. For children with cystic fibrosis, who as mentioned above are predisposed to rectal prolapse, adjustment of pancreatic enzymes is important.[1] Further management is indicated when patients complain of longstanding symptoms, rectal pain, rectal bleeding, rectal ulceration, or difficult manual reduction of the prolapsed rectum.[8] Injection sclerotherapy is often the first intervention, followed by Thiersch cerclage, and finally rectopexy.[1]

Differential Diagnosis

The differential diagnosis for rectal prolapse includes ileocecal intussusception, prolapsing rectal polyp, prolapsing rectal duplication cyst, and rectal hemorrhoids. While rectal prolapse is painless, intussusception presents with intermittent severe pain. Examination of prolapse tissue can distinguish between prolapsing rectal polyp, prolapsing rectal duplication cyst, and rectal hemorrhoids due to the circumferential nature of prolapse.[1]

Prognosis

The prognosis of rectal prolapse is generally good, especially when diagnosed between the age of 9 months and 3 years and not associated with any other underlying condition. It is usually a condition of childhood and often does not recur after age 6. When rectal prolapse is diagnosed after age 4, children are more likely to have underlying neurologic or musculoskeletal problems requiring surgical management and symptoms into adulthood.[1][4]

Complications

Most complications are from surgery and may include:

Enhancing Healthcare Team Outcomes

Rectal prolapse is ideally managed by an interprofessional team that involves a pediatrician, gastroenterologist, pediatric surgeon, and a pediatric nurse. All children with rectal prolapse should undergo testing for cystic fibrosis. While awaiting surgery, parents should be taught how to reduce the rectal prolapse.[9][10]

Coordination of care for rectal prolapse requires a highly organized interprofessional team. For diagnosis and conservative management, physicians, nurses, and families must work together for effective treatment and maintenance at home. If these treatments are effectively communicated and orchestrated, the patient will ultimately have a better outcome. If surgery is indicated for prolapse, coordination is also needed between physicians, nurses, pharmacists, and other members of the healthcare team. The importance of communication, patient-centered care, and professionalism cannot be understated when working with pediatric populations.[11]

Figure

A full thickness external rectal prolapse, and B mucosal prolapse. Note circumferential arrangement of folds in full thickness prolapse compared to radial folds in mucosal prolapse. Contributed From the https://www.ncbi.nlm.nih.gov/pmc/ (Public Domain) (more…)

References

1.: Rentea RM, St Peter SD. Pediatric Rectal Prolapse. Clin Colon Rectal Surg. 2018 Mar;31(2):108-116. [PMC free article: PMC5825854] [PubMed: 29487493]
2.: Corman ML. Rectal prolapse in children. Dis Colon Rectum. 1985 Jul;28(7):535-9. [PubMed: 3893949]
3.: Antao B, Bradley V, Roberts JP, Shawis R. Management of rectal prolapse in children. Dis Colon Rectum. 2005 Aug;48(8):1620-5. [PubMed: 15981062]
4.: Siafakas C, Vottler TP, Andersen JM. Rectal prolapse in pediatrics. Clin Pediatr (Phila). 1999 Feb;38(2):63-72. [PubMed: 10047938]
5.: Hill SR, Ehrlich PF, Felt B, Dore-Stites D, Erickson K, Teitelbaum DH. Rectal prolapse in older children associated with behavioral and psychiatric disorders. Pediatr Surg Int. 2015 Aug;31(8):719-24. [PubMed: 26163086]
6.: Koivusalo AI, Pakarinen MP, Rintala RJ. Rectopexy for paediatric rectal prolapse: good outcomes but not without postoperative problems. Pediatr Surg Int. 2014 Aug;30(8):839-45. [PubMed: 24990243]
7.: White CM, Findlay JM, Price JJ. The occult rectal prolapse syndrome. Br J Surg. 1980 Jul;67(7):528-30. [PubMed: 7417757]
8.: Jacobs LK, Lin YJ, Orkin BA. The best operation for rectal prolapse. Surg Clin North Am. 1997 Feb;77(1):49-70. [PubMed: 9092117]
9.: van der Schans EM, Paulides TJC, Wijffels NA, Consten ECJ. Management of patients with rectal prolapse: the 2017 Dutch guidelines. Tech Coloproctol. 2018 Aug;22(8):589-596. [PubMed: 30099626]
10.: Kelley BR, Beauchesne MA, Ott MJ, Graham JM, Burton M. Preschool child with rectal prolapse. J Pediatr Health Care. 1997 Jan-Feb;11(1):40-1, 47-8. [PubMed: 9052135]
11.: Minaev SV, Kirgizov IV, Gladkyy A, Shishkin I, Gerasimenko I. Outcome of Laparoscopic Treatment of Anorectal Malformations in Children. World J Surg. 2017 Feb;41(2):625-629. [PubMed: 27553198]

Anorectal Disease: Rectal Prolapse

Abstract

Rectal prolapse is a condition that usually requires surgical intervention to correct. Abdominal and perineal approaches are well described in the literature. Abdominal approaches have traditionally been reserved for young healthy patients, but this has been challenged by perineal approaches with excellent outcomes. Laparoscopic techniques have been shown to be effective and equivalent to traditional laparotomy techniques.

Keywords: Rectal prolapse, procidentia, perineal proctectomy, Delorme procedure, Altemeier procedure

Rectal prolapse is the complete protrusion of the rectum through the anal canal. Rectal bleeding and a mucoid discharge are frequent symptoms. Incontinence is frequently associated with this condition as a result of either an underlying weakened sphincter, which allows the prolapse to occur, or secondarily to chronic straining and injury to the sphincter complex due to the chronic rectal prolapse.

Rectal prolapse is most frequently seen in elderly multiparous women. Other risk factors include connective tissue and psychiatric disorders as well as obesity.¹^,²^,³

ETIOLOGY

The exact cause and mechanism of rectal prolapse is not completely understood. Numerous possibilities have been proposed. Rectal prolapse may be seen in childhood suggesting a congenital defect in the pelvic connective tissue or sphincter musculature.⁴ Pregnancy, obesity, perineal injury, chronic constipation, or other conditions resulting in increased intra-abdominal pressure are associated with rectal prolapse. Anatomic variations, such as a deep cul-de-sac of Douglas and redundant sigmoid colon, are frequently associated with the condition and may be causal.

CLINICAL FEATURES

The chief clinical feature of rectal prolapse is a protruding mass following defecation (see Fig. ¹). At times, the prolapse may occur spontaneously upon standing or coughing. Rectal bleeding may be noted following bowel activity. Rectal prolapse frequently is accompanied by a mucoid discharge. A hemorrhoidal prolapse may be associated with similar symptoms and must be distinguished from a rectal prolapse by a careful physical examination.

A rectal prolapse reveals circular mucosal folds. It is generally not tender to palpation. A hemorrhoidal prolapse is a more radially appearing prolapse (see Fig. ²). The anal orifice may be patulous and a large protruding red mass is seen with a rectal prolapse. Frequently, the prolapse will be in a reduced state when the patient is initially examined. Placing the patient on a commode and asking them to strain will usually elicit the prolapse.

Incontinence frequently accompanies rectal prolapse.⁵ Usually, there is a long history of constipation, which precedes the prolapse by many years. It is possible that weakening of the pelvic musculature as a result of chronic defecatory straining initiates the prolapse. Baseline manometric physiologic testing to establish the state of the sphincter mechanism may be helpful.

COMPLICATIONS

The most important complication of rectal prolapse is incarceration and strangulation. Most often the rectal prolapse will reduce spontaneously. The prolapse may also at a later stage require manual reduction, which with time becomes more frequent and difficult. An incarcerated rectal prolapse may be seen after a long history of prolapse or less frequently as a presenting symptom.

The treatment of an incarcerated viable prolapse is to place the patient in the head-down position, applying cold compresses to the protruding mass. Injection of the anal sphincter with local anesthesia may also be helpful. After the swelling is diminished, an attempt at manual reduction is performed. If reduction is not successful or if the prolapse is strangulated, urgent operative therapy is required. A perineal approach is most appropriate. A gangrenous prolapse should always be approached by a perineal technique to avoid soiling of the peritoneal cavity by necrotic tissue.⁶

TREATMENT

The operative approach to rectal prolapse is controversial. Numerous factors must be considered, such as the patient’s age, comorbidities, gender, and importantly, preoperative constipation. Abdominal and perineal operations are the main surgical choices.

Abdominal Approaches

The main abdominal operations performed in the United States involve suture rectopexy alone or in conjunction with a sigmoid resection. Rectal fixation utilizing synthetic materials has all but been abandoned as a result of associated complications such as infection, bowel erosion, and obstruction.⁷^,⁸^,⁹

The abdominal approach to repair a rectal prolapse involves mobilization of the rectum from the sacrum to the level of the anorectal junction posteriorly. After a complete rectal mobilization is performed, a posterior rectopexy is performed by direct suture fixation to the upper sacrum. Care must be taken to assure that the rectum has been completely mobilized. Failure to straighten the rectum completely could result in an immediate failure due to continued prolapse of the rectal segment distal to that, which has been “pexed” to the sacrum. Recurrence rates in the order of 0 to 9% are reported (see Table ).

Table 1

Results of Suture Rectopexy for Rectal Prolapse

Source	N	Recurrence (%)	Follow-Up (yr)
Carter,1983⁵⁰	32	3	12
Blatchford et al, 1989⁵¹	42	2	2.3
Novell et al,1994⁹	32	3	3.9
Graf et al, 1996⁵²	53	9	8
Khanna et al,1996⁵³	65	0	5.4
Briel et al,1997⁵⁴	24	0	5.6

A sigmoid resection may be added to the rectopexy as reported by Frykman et al (see Fig. ³).¹⁰ Patients with a significant history of constipation coupled with a redundant sigmoid colon appear to be benefited by the addition of resectional therapy. Careful preoperative questions regarding bowel activity are imperative. At times, transit studies are a useful adjunct.

Sigmoid resection and rectopexy.

In the rectopexy with resection technique, the sigmoid colon is mobilized and a standard resection is performed utilizing a stapled or hand-sewn anastomosis. The descending colon is not mobilized. This should support the anastomosis and prevent recurrent prolapse. By removing the redundant sigmoid colon, constipation should be improved resulting in less straining, which should also help prevent recurrent prolapse.⁷^,¹¹^,¹²^,¹³^,¹⁴

Rectopexy combined with anterior sigmoid resection is currently the most popular operation in the United States for rectal prolapse. Recurrence rates in the order of 0 to 9% are expected (see Table ).

Table 2

Results of Suture Rectopexy with Resection

Source	N	Recurrence (%)	Follow-Up (yr)	Mortality (%)
Frykman and Goldberg,1969¹²	80	0	NS	NS
Watts et al,1985²⁹	138	2	4	0
Husa et al,1988⁵⁵	48	9	4.3	0
Sayfan et al, 1990⁵⁶	13	NS	NS	0
Luukkonen et al,1992⁵⁷	15	0	NS	6.7
McKee et al, 1992⁵⁸	9	0	1.8	0
Tjandra et al, 1993⁵⁹	18	NS	4.2	0
Deen et al, 1994³¹	10	0	1.4	0
Huber et al, 1995⁶⁰	42	0	4.5	0
Yakut et al, 1998³⁸	19	0	3.2	0
Kim et al, 1999³³	176	5	8.2	NS

Laparoscopy

The first laparoscopic rectopexy was reported in 1993.¹⁵ Surgeons are becoming more familiar with laparoscopic rectal surgery in general, and there is no reason that this technique could not apply to rectopexy or rectopexy with sigmoid resection.

Two randomized reports compared open versus laparoscopic procedures utilizing mesh rectopexy.¹⁶^,¹⁷ Both studies confirmed no difference in recurrence rates. The laparoscopic group did show less morbidity and a shorter period of hospitalization.

Ashari et al¹⁸ reported a recurrence rate of 2.5% in 117 patients treated by laparoscopic rectopexy over a 10-year period with a low morbidity rate of 9% and a 0.8% mortality rate. Kariv et al¹⁹ reported the Cleveland Clinic experience with the laparoscopic approach. This was a case-match series comprising 111 laparoscopic with 86 open procedures. Hospital stay was reduced in the laparoscopic group (3.9 vs 6 days). The recurrence rate was 9.7% in the laparoscopic group compared with 4.7 in the open group. The difference is not statistically significant.

Perineal Approaches

Historically, the perineal approaches to rectal procidentia have higher recurrence rates, and as such have been reserved for more frail, elderly, and high-risk patients. The decreased perioperative morbidity balances the increased recurrence rate. However, recurrence rates comparable to abdominal approaches have been described with the perineal rectosigmoidectomy with levatorplasty.²⁰^,²¹^,²²^,²³ Importantly, perineal approaches avoid the extensive pelvic dissections required for abdominal procedures. This avoids the potential for nerve injury associated with erectile dysfunction in young men, as well as the potential for fecundity in young women. The three most commonly performed procedures are the perineal rectosigmoidectomy (Altemeier procedure), the perineal rectosigmoidectomy with levatorplasty, and the Delorme procedure.

Perineal Rectosigmoidectomy

Resection of the rectum via the perineum was first described by Mikulicz in 1889²⁴ and Miles in 1933.²⁵ The perineal rectosigmoidectomy bears the name Altemeier, as popularized by Altemeier and Culbertson in 1971.²⁶^,²⁷^,²⁸ A transanal approach is used to perform a full-thickness excision of the rectum and a portion of the sigmoid colon. An anastomosis is then performed utilizing interrupted absorbable sutures or a circular stapling device. Excision of the redundant anterior peritoneum forming a deep pouch of Douglas should be performed as part of the resection. Perineal rectosigmoidectomy is the procedure of choice for patients presenting with an incarcerated, gangrenous rectal prolapse. The Altemeier operation is also a good option for patients with a recurrence after another perineal procedure.

Mortality rates range from 0–5% and recurrence rates range from 0–16% (see Table ).²⁸^,²⁹^,³⁰^,³¹^,³²^,³³ Complete mobilization is critical to the success of the procedure. Resecting too much bowel can lead to an anastomosis under tension and ligating the mesentery too far proximally can lead to ischemia. Conversely, not resecting all the redundant bowel can lead to recurrence. This procedure has been reported to yield poor functional results related to soiling, fecal urgency, and fecal incontinence due to the loss of rectal reservoir function with a narrow colon above the anal anastomosis.³¹^,³⁴

Table 3

Results of Perineal Rectosigmoidectomy for Rectal Prolapse

Source	N	Study	Levatorplasty	Mortality (%)	Continence (%)	Constipation (%)	Recurrence (%)	Follow-Up (yr)
Altemeier et al, 1971²⁸	106	Retrospective	No	0	NS	NS	3 (3)	19
Watts et al, 1985²⁹	33	Retrospective	No	0	6 ( + ), 22 (-)	NS	0	1.9
Prasad et al, 1986²²	25	NS	Yes	0	88 ( + )	NS	0	NS
Williams et al, 1992²³	56	Retrospective	No	0	46 ( + ), 0 (-)	NS	6 (6)	1
Williams et al, 1992²³	11	Retrospective	Yes	SN	91 ( + )	NS	0	1
Johansen et al, 1993³⁰	20	NS	No	1 (5)	21 ( + )	NS	0	2.2
Deen et al, 1994³¹	10	Prospective	No	0	80	NS	1 (10)	1.5
Ramanujam et al, 1994³²	72	NS	No	0	67 ( + )	NS	4 (6)	10
Agachan et al, 1997²¹	32	Retrospective	No	0	( + )	NS	4 (13)	2.5
Agachan et al, 1997²¹	21	Retrospective	Yes	0	( + )	NS	1 (5)	2.5
Kim et al, 1999³³	183	Retrospective	No	NS	53 ( + )	61 ( + )	29 (16)	3.9
Takesue et al, 1999²⁰	10	NS	Yes (7/10)^*	0	(+)	NS	0	3.5

Perineal Rectosigmoidectomy with Levatorplasy

The perineal rectosigmoidectomy with levatorplasty has the largest recurrence-free interval, the lowest recurrence rate, and the most salutary effects on constipation and incontinence.⁵ Adding the posterior levatorplasty recreates the anorectal angle, seems to improve continence, and also improves the short-term recurrence rate over the perineal rectosigmoidectomy alone.²¹ Of the three perineal options, namely the Delorme procedure, the perineal rectosigmoidectomy, and the perineal rectosigmoidectomy with levatorplasty, the perineal rectosigmoidectomy with levatorplasty has the longest recurrence-free interval, the lowest overall recurrence rate, and the best effects in relation to incontinence and constipation.⁵

Delorme Procedure

Delorme first described this procedure in 1900.³⁵ This procedure is well suited for patients with partial circumference or short-segment full-thickness prolapse.⁵^,²⁰ It is also an effective treatment for mucosal or partial thickness rectal prolapse.³⁶ A transanal approach is used to dissect the mucosa and submucosa from the sphincter complex and the muscularis propria. The redundant musoca and submucosa is excised and reanastomosed after the muscularis propria is plicated

Mortality rates range from 0 to 4% and recurrence rates range from 4 to 38%,⁵^,²¹^,³⁶^,³⁷^,³⁸^,³⁹^,⁴⁰^,⁴¹^,⁴²^,⁴³^,⁴⁴ listed in Table . Morbidity is relatively uncommon and includes hemorrhage, anastomotic dehiscence, stricture, diarrhea, and urinary retention. Factors associated with poor outcomes include proximal lead point with retrosacral separation seen on defecography, fecal incontinence, chronic diarrhea, and major perineal descent (> 9 cm on straining).⁴⁵

Table 4

Results of Delorme Procedure for Rectal Prolapse

Source	N	Study	Mortality (%)	Continence (%)	Constipation (%)	Recurrence (%)	Follow-Up (yr)
Oliver et al, 1994⁴²	41	Retrospective	1 (2.4)	58 ( + )	NS	8 (22)	3.9
Senapati et al, 1994³⁷	32	NS	0	46 ( + )	50 ( + )	4 (12.5)	1.8
Tobin and Scott, 1994³⁶	43	Prospective	0	50 ( + )	NA	11 (26)	1.7
Lechaux et al, 1995⁴⁰	85	Retrospective	1 (1.2)	45 ( + )	100 ( + )	11 (14)	2.8
Kling et al, 1996⁴³	6	Retrospective	0	67 ( + )	100 ( + )	1 (17)	11
Agachan et al, 1997²¹	8	Retrospective	0	( + )	NS	3 (38)	24
Pescatori et al, 1998³⁹	33	Retrospective	0	( + )	44 ( + )	6 (18)	0.9
Yakut et al, 1998³⁸	27	Retrospective	0	NS	NS	4 (4.2)	3.2
Lieberman et al, 2000⁴⁴	34	Retrospective	0	32 ( + )	88 ( + )	0	3.6
Watts and Thompson, 2000⁴¹	101	Retrospective	4 (4)	25 ( + )	13 ( + )	30 (27)	3

Anal Encirclement

Another option for severely ill patients, with significant comorbidities or portal hypertension, is anal encirclement. First described by Thiersch in 1891,⁴⁶ this technique involves encircling the anal canal, thereby narrowing it. This method does not correct the prolapse, rather it provides a physical barrier preventing further prolapse. Although anal encirclement has a high recurrence rate, 33 to 44%,⁷^,¹¹^,⁴⁷^,⁴⁸^,⁴⁹ it may be an option for patients at very high risk for operative interventions. Providing some palliation for the prolapse may be worth the subsequent difficulties with evacuation frequently encountered after anal encirclement procedures.

SURGICAL DECISION MAKING

The choice of operation facing the surgeon is whether to offer an abdominal (open or laparoscopic) or a perineal approach.

The perineal approach is attractive because of similar recurrence rates to abdominal procedures and easier repeatability if recurrence occurs. The perineal approach is less invasive than open approaches and is associated with shorter hospital stays. It is ideal for the elderly or patients with significant comorbidities. The perineal approach can be done under regional anesthesia. The perineal approach may also be appealing to young men with sexual dysfunction as a concern.

The abdominal approach is best suited to young healthy patients with significant constipation and sigmoid redundancy and incontinence.

A randomized controlled trial of perineal proctosigmoidectomy with pelvic floor reconstruction versus open resection rectopexy and pelvic floor reconstruction showed no difference in recurrence rates; however, incontinence was significantly improved in the resection rectopexy group.³¹

CONCLUSION

Rectal prolapse is a chronic disturbing condition, which affects elderly women primarily, usually with a history of chronic constipation with varying degrees of incontinence. The precise etiology is unclear and there are numerous surgical options. Therapeutic decision-making is even more challenging in the younger patient population particularly in men with sexual dysfunction as an important concern.

Perineal procedures offer the advantage of a less-invasive operation with results similar to open procedures. The perineal operations can be repeated should recurrent prolapse develop. This approach would seem most appropriate in elderly debilitated and young male patients with sexual dysfunction as an important consideration. Young women may opt for a perineal procedure when cosmesis is important. Laparoscopic operations may also result in acceptable cosmesis.

Open or laparoscopic options would appear to benefit patients with significant longstanding constipation with marked sigmoid colon redundancy. Preoperative transit studies should be utilized to define the extent of the colonic dysfunction.

The ultimate decision should be made by the patient and physician after reviewing the options, risks, and benefits of the various operative techniques, and which approach best suits the individual patient.

As surgeons become more familiar with laparoscopic approaches, we will probably see a shift in this direction. Long-term outcomes following laparoscopic surgery for rectal prolapse appear to equal open techniques and this may emerge as the procedure of choice in the future.

90,000 Rectal prolapse – causes, symptoms and treatment

Rectal prolapse (rectal prolapse, pelvic floor prolapse)

Rectal prolapse is a condition when the rectum or part of it loses its proper position inside the body, becomes mobile, stretches and comes out through the anus. Rectal prolapse is divided into two types: internal (hidden) and external. Internal prolapse of the rectum differs from the external in that the rectum has already lost its position, but has not yet come out.Rectal prolapse is often accompanied by weakening of the anal muscles, which leads to incontinence of gas, feces and mucus.

The problem of rectal prolapse occurs in our patients quite often. This condition is also known as rectal prolapse or pelvic floor prolapse and is more common in women than men.

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

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

Rectal prolapse usually responds well to treatment and has a low relapse rate (re-emergence of the disease) – only about 15%. Complications in treatment usually occur with late treatment of the patient for specialized help and attempts to self-diagnose and treat.As a result of these actions – lost time for success in treatment. If you do not take any treatment, 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:

Ulcers of the rectal mucosa.
Tissue necrosis (necrosis) of the rectal wall.
Bleeding.
Incontinence of gas, mucus and feces.

The length of time over which these changes occur varies widely and differs from person to person, no doctor will give an exact time frame for these serious disorders.

Normal

With prolapse

Rectal prolapse and hemorrhoids

One of the common reasons why a patient does not go to the doctor immediately after a problem occurs is the external similarity of the manifestation of the disease with hemorrhoids, which they are trying to cure on their own – with suppositories and ointments.In fact, rectal prolapse and hemorrhoids are completely different diseases, which outwardly can really seem similar due to the inflow of tissue from the anal canal. Only with hemorrhoids does hemorrhoidal tissue fall 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 misdiagnosis and inappropriate 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 the pressure inside the abdomen can trigger the development of rectal prolapse. Constipation, diarrhea, prostatic hyperplasia (straining when urinating), pregnancy and childbirth, persistent cough.
Injury to the anus, pelvic floor muscles, back nerves, pelvic nerves from previous surgery or injury.
Infections of the intestine with certain types of microbes called parasites (such as amebiasis and schistosomiasis).
Certain diseases of the nervous system, such as multiple sclerosis.
Constipation-related mental health conditions such as: depression, anxiety, side effect of medications used to treat mental disorders.

Symptoms of rectal prolapse

The most common symptom that should alert you is the sensation of a foreign body in the anus coming out of the anus. In the early stages, this can happen during straining, but as the condition progresses, it can happen when coughing, sneezing, standing up, or walking.
In the early stages, when the prolapse is relatively minor, manual assistance (insertion of the intestines with the fingers) will be successful, but over time this will not be possible.
Feeling of incomplete emptying of the intestine – usually occurs in the case of latent (internal) prolapse of the rectum.
Fecal incontinence resulting in contamination of clothing. Incontinence of gas, loose and hard stools, or mucus / blood may also occur.
Constipation occurs in up to 30-50% of patients with rectal prolapse.Constipation can occur due to congestion in the rectum, creating a blockage that gets worse with exertion.
Pain and discomfort in the anus.
Bleeding – Over time, the mucous membrane that has fallen out can become thick and ulcerated, causing bleeding.

Diagnostics

In most cases, an experienced physician will be able to make a diagnosis during the initial examination. However, there are additional research methods that can assess the severity of the disease and help in choosing the right treatment method.

Studies 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 malfunction. It also looks at 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 holding function.
Transrectal ultrasound examination. E This test helps assess the shape and structure of the muscles of the anal sphincter and surrounding tissues.
Proctography (defecography). This study evaluates how well the rectum holds stool and how well the rectum empties.
Colonoscopy. Allows you to visually examine the entire colon and helps to identify certain 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 on a multidisciplinary basis, that is, jointly.

Treatment of rectal prolapse

Our Clinic provides the entire spectrum of rectal prolapse treatment. Based on the stage of the disease and its manifestation, our specialists select the most optimal method of treatment. It is important to understand that rectal prolapse is a complex disease that cannot be treated without surgery.For the treatment of rectal prolapse in our Clinic, the following surgical techniques are used:

Abdominal operations (operations through the abdominal cavity)

1. Rectosacropexy operation – a mesh allograft (alloprosthesis) is used for it, 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. The Kummel operation is the fixation of the previously mobilized rectum to the promontory of the sacrum with interrupted sutures.

These operations can be performed both by open access through incisions (laparotomy) and laparoscopic through small punctures.

Transanal operations (operations through the anal canal)

1. Operation Delorma is the removal (resection) of the mucous membrane of the prolapsed section of the intestine with the formation of a muscle cuff, which holds the intestine, preventing it from falling out.

2. Altmeer’s operation – resection of the rectum or its prolapsed area with the formation of a coloanal anastomosis – joining the large intestine 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 loss – 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 regain their gastrointestinal function.After the operation, it is important to control the stool, avoid constipation and strong straining.

Rectocele – ProMedicine Ufa

Rectocele – diverticulum-like protrusion of the rectal wall towards the vagina, accompanied by a disorder of the act of defecation. Rectocele can be manifested by constipation, a feeling of incomplete emptying of the intestines, the need for pressure on the perineum, the buttocks area, or the vaginal wall to empty the intestines. Development of hemorrhoids, anal fissures, cryptitis, pararectal fistulas and other complications is possible.

With age, the likelihood of rectocele increases. Pathology is accompanied by a disorder of the evacuation function of the intestine, while the degree of disorder of the act of defecation directly depends on the severity of the rectocele. In severe cases, bowel movements without additional help (squeezing out fecal masses through the vaginal wall) becomes impossible, other proctological and gynecological diseases develop.

Reasons

A pathology such as rectocele can appear for the following reasons:

– constipation for a long time, which leads to rectal dysfunction;
– weakness, and congenital, of the musculo-ligamentous skeleton of the pelvic floor;
– pathological changes that have occurred in the levators, that is, in the muscles that raise the anus;
– seriously changed rectovaginal septum;
– dysfunction of the anal sphincter;
– various pathologies of the genital organs;
– dystrophy or atrophy of the rectovaginal septum, as well as the muscular group of the pelvic floor, which is associated with age-related changes in the woman’s body;
– chronic bronchitis, which is accompanied by bouts of severe coughing;
– too strong physical activity, for example, rectocele may well develop from heavy bags;
– obesity.

Symptoms

The following symptoms are characteristic of rectocele: Difficult stool; increased urge to defecate; feeling of incomplete emptying; when coughing, sneezing, urinary incontinence is observed; unpleasant and painful sensations during intercourse.

Women feel several symptoms of this unpleasant disease at once. The main one is the bulging of the rectal wall, which is felt as a foreign object in the vagina. It is accompanied by discomfort, as well as pain during intercourse.As a result, minor vaginal bleeding may occur, which is different in nature from menstruation.

The disease is accompanied by stool retention, strong straining due to difficulty in emptying. Pressing on the back wall of the rectum somewhat facilitates the process of defecation. However, after emptying, when the woman returns to an upright position, the urge to defecate is repeated. This is due to the movement of feces into the lower rectum.

Diagnostics

The diagnosis is made according to the results of a digital examination of the rectum: when straining, a protrusion of the intestinal wall is detected.

Laboratory research methods are also prescribed: clinical and biochemical analyzes of blood and erythrocytes, fecal occult blood test, coprogram – fecal analysis (undigested food fragments, large amounts of fat, coarse dietary fiber can be detected).

Instrumental research methods:

– Method of dynamic defectoproctography – X-ray examination of the intestine during the process of defecation (emptying of the rectum) to identify possible damage to the musculo-ligamentous apparatus, difficulties in defecation.
– Sigmoidoscopy (visual examination of the rectum and part of the sigmoid with a special apparatus – an endoscope), the main method for diagnosing rectocele.
– Irrigoscopy (X-ray examination of the large intestine with the introduction of a radiopaque (clearly identifiable in the picture) substance).
– Colonoscopy (visual examination of the large intestine using an endoscope). When carrying out these studies, a protrusion of the rectal wall is detected.
– Computed tomography (CT) is performed to assess the condition of other organs of the abdominal cavity (liver, pancreas, bladder, kidneys, part of the unchanged intestine) and if complications of rectocele are suspected to identify them.
– Ultrasound examination (ultrasound) of the abdominal cavity and small pelvis to assess the state of the gallbladder, biliary tract, pancreas, kidneys, intestines, to establish signs of stool retention in the intestine.

Treatment

Treatment should begin with the regulation of the proper functioning of the intestines, which consists in following a certain diet. It is recommended that you eat foods high in fiber and drink six to eight glasses of liquid daily.Fiber is able not only to increase the volume of feces, but also to make its consistency softer, as a result of which fecal masses move through the intestines without any particular difficulty and are more easily released. It is allowed to take means for softening feces.

If the symptoms of rectocele, which are treated with conservative methods, persist, the doctor decides to perform a surgical intervention in order to remove the protruding part of the rectum and strengthen the rectovaginal septum.The rectocele operation can be performed in many ways. The indications for its implementation is a strong bulging of the rectocele, spreading to the vestibule of the vagina or even beyond the genital tract. Operational access to the anterior rectal wall can be through the vagina, rectum, perineum, or through the abdominal cavity. In this case, both general anesthesia and epidural anesthesia are possible. Mild forms of pathological changes are eliminated under local anesthesia.

Rectal prolapse – ProMedicina Ufa

Rectal prolapse

– violation of the anatomical position of the rectum, in which there is a displacement of its distal part outside the anal sphincter.Rectal prolapse may be accompanied by pain, incontinence of intestinal contents, mucous and bloody discharge, sensation of a foreign body in the anus, false urge to defecate. Diagnosis of rectal prolapse is based on examination data, rectal digital examination, sigmoidoscopy, irrigoscopy, manometry. Treatment of rectal prolapse is mainly surgical; consists in performing resection and fixation of the rectum sphincter plastics.

Causes

Among the possible causes of rectal prolapse, it is possible to single out the causes of producing and predisposing.

The first group includes those factors that can cause protrusion of the rectal segment, for example, heavy physical exertion, in particular, a single overstrain, as well as regular hard physical labor. This also includes: frequent constipation, in which a person is constantly forced to push hard; complications arising during labor in women, in particular, perineal ruptures and traumatic injuries of the pelvic muscles; previous surgical interventions in the intestinal area; traumatic injury to the sacrum; the presence of ulcerative foci on the surface of the intestinal mucosa.

The predisposing factors that significantly increase the risk of developing the disease include: various anatomical defects in the structure of the pelvis and intestines, for example, the vertical position of the coccyx or lengthening of the rectum; diseases of the gastrointestinal tract and genitourinary system; hobby for non-traditional types of sex associated with the risk of injury to the rectum; decreased tone of the anal sphincter, sprains – conditions typical mainly for the elderly; general dysfunction of the pelvic organs; neurological disorders affecting the spinal cord; hereditary predisposition.

Symptoms

The onset of the disease can be either gradual or acute. During an acute course, the rectum falls out at one point. This mainly happens with strong straining, sharp lifting of weights, etc. Such phenomena are accompanied by unpleasant sensations in the perineum and in the muscles of the anterior abdominal wall, as well as the occurrence of severe pain in the anus. As for the gradual course, it develops due to high intra-abdominal pressure – for example, with constant constipation.In such a situation, intestinal prolapse is observed, which then becomes more pronounced, and ultimately there is a complete prolapse of the rectal ampulla (prolapse).

Diagnosis

For diagnosis, the doctor needs a detailed history of the disease and a thorough examination of the anorectal region. To determine rectal prolapse, the patient may be asked to strain while sitting on the toilet seat, thereby imitating the act of defecation (emptying the rectum). Sometimes rectal prolapse can be “hidden” or internal, in which case the diagnosis of the disease can be difficult.To determine the degree of rectal prolapse, a special X-ray examination is used – defecography. During this procedure, X-rays are taken while simulating a bowel movement. This helps the doctor determine the severity of anatomical and functional disorders, as well as the need and method of surgical treatment. Anorectal manometry can also assess the function of muscles located around the intestine and assess their participation in the act of defecation.

Treatment

Therapy of initial forms of rectal prolapse most often involves the use of conservative methods.Immediately, we note that almost all conservative methods, such as physiotherapy, pararectal injections of sclerosing drugs, stimulation of the sphincter muscles and pelvic floor, do not give a 100% guarantee of a complete cure of the patient. That is why almost all experts recommend surgical intervention in the fight against this pathology. Moreover, the earlier the patient is operated on, the more chances to avoid the development of certain complications.

Only children are an exception to the rule, since in childhood the operation can be delayed.With the development of this pathological condition in a child, he should first of all be taught to go to the toilet according to a certain regimen. Of course, such training will take a lot of time, but you can still achieve the desired result. In addition, it is very important to feed your baby with foods that are high in fiber. The correct water toilet after a bowel movement is also important.

As for surgical interventions, today there are about fifty of them, and almost all of them are effective.The most commonly used surgical interventions in the fight against rectal prolapse include:

– stitching of the rectum;
– resection of a part of the large intestine;
– plastic surgery on the muscles of the pelvic floor and rectal canal;
– an operation that is aimed at a fallen out fragment of the intestine;
– a combination of different methods.

The choice of the surgical method depends on the general condition of the patient, the severity of the disease, the patient’s age, etc.Modern technologies of surgical treatment make it possible to perform surgical interventions using laparoscopy, which significantly shortens the recovery period and reduces the risk of complications.

Clinical Hospital | Rectocele (pelvic floor muscle prolapse syndrome)

Rectocele – diverticular protrusion (“pocket”) of the anterior rectal wall towards the vagina.

This disease is detected in 15-43% of women, accompanied by constipation, difficulty in defecation, a feeling of incomplete emptying of the rectum.At the same time, patients mistakenly believe that the cause of constipation is reduced motility of the large intestine. In fact, these complaints are associated with anatomical changes in the rectovaginal septum.

Symptoms

For patients with rectocele, multi-stage defecation is characteristic, often there is a need for manual assistance during defecation (by pressing a finger on the back wall of the vagina or perineum) or using cleansing enemas to empty the rectum, and unpleasant and painful sensations during sexual intercourse (dyspareunia) also appear.

Violation of the process of stool evacuation and its delay in the “pocket” of the anterior rectal wall is accompanied by inflammatory changes in the distal colon. Further development of the disease leads to a change in the functional state of the rectum and pelvic floor muscles, causing physical and psychological suffering, which can manifest itself as partial disability. With the progression of the disease, the appearance of concomitant pathology of the anal canal and rectum (anal fissures, hemorrhoids) is possible.

Due to the fact that rectocele is not always diagnosed on time, women are treated for a long time and unsuccessfully for constipation, and in most cases plastic surgery is necessary.

Treatment

There are numerous methods of surgical correction of rectocele, which are divided by the nature of the operative access (transanal, transvaginal and perineal).The main disadvantage of these methods is the long and difficult postoperative period.

In recent years, an innovative technology for surgical treatment of rectocele has been introduced and successfully applied in our clinic: the TRREMS operation (transanal correction of rectocele and rectal mucosectomy), which allows achieving very good cosmetic and functional results. Surgery is performed through the rectal lumen and the stitches remain inside. The operation is aimed at resection of the altered structures of the rectal wall with the elimination of its prolapsing section and the creation of a connective-muscular frame of the intestinal wall.This technique is low-traumatic and easily tolerated, accompanied by the absence of pain in the postoperative period, short hospital stay and speedy recovery.

Rectum prolapse in a cat – symptoms, diagnosis, treatment (surgery)

The rectum is the area of the large intestine that ends in the anus.Rectal prolapse, or rectal prolapse, is the protrusion of the rectal mucosa beyond the anal sphincter. Depending on the severity, there is a partial prolapse of the intestine and the complete loss of the entire thickness of the intestinal wall.

The causes leading to rectal prolapse can be various diseases that require considerable stress from the animal during bowel movements, urination or during childbirth. Most often, young animals suffer from frequent diarrhea or constipation, mainly associated with parasitic, viral diseases or improper feeding.Also, unproductive attempts to urinate with diseases of the urinary system (urolithiasis, cystitis, etc.), difficult childbirth can lead to excessive stress. Various diseases related to the genitourinary system and intestines (inflammation or enlargement of the prostate, bladder, urolithiasis or inflammation and intestinal tumors) often threaten the animal with a bad scenario. Prolapse of the rectum occurs when the tone and relaxation of the sphincter of the anus are weakened.

Symptoms that can alert vigilant owners and cause a visit to a veterinarian are: frequent, painful urge to defecate (or urinate), while the rectal area coming out of the anus is visualized, which, depending on the severity of the condition, can ” leave “after a bowel movement or stay in this position.In this case, bleeding, ulceration or necrosis of the mucous membrane can be observed.

The main task in the treatment of this problem is to eliminate the root cause of the disease, that is, the problem that led to rectal prolapse. In order for the animal to receive adequate treatment, it is necessary to conduct a number of diagnostic studies. The veterinary specialist, based on the anamnesis data, prescribes the studies necessary in his opinion: a general clinical and biochemical blood test, an analysis of feces for the presence of protozoa and helminths in it, a colonoscopy, an X-ray, an ultrasound scan, etc.After the diagnosis is established, the necessary therapy is immediately started and the intestines are adjusted. Depending on the degree of prolapse, there are several options for eliminating rectal prolapse: in case of intestinal prolapse while maintaining its viability, mechanical reduction is performed with a purse-string suture applied for an average of 5 days, with further relapses, colonopexy is recommended. If the lesion is significant and signs of necrosis are evident, resection of the affected area of the intestine is performed.

In any case, if you suspect this pathology in your animal, you must contact a veterinary clinic, where you can be provided with qualified timely assistance.

The article was prepared by A. Kuznetsova,

What to do if a cat has a rectum

Prolapse of the rectum in a cat is the exit of the presenting layers of the intestine to the outside through the anus. Such a disease is often diagnosed in pets with helminthic invasion, as well as with malnutrition and prolonged chronic constipation.Without timely treatment (for example, manual reduction), rectal prolapse can lead to serious consequences for the pet, up to and including death. Experts from a veterinary clinic in Moscow talk about how the disease is diagnosed and what methods are used in the treatment of an animal.

Read this article :

Why does a cat have rectum prolapse?
Signs of rectal prolapse
Prognosis
Diagnosis of the disease
How is rectal prolapse treated in cats?
How to prevent the development of rectal prolapse?

Why does a cat have rectum prolapse?

Chronic constipation is a common cause of rectal prolapse in cats. .This is due to the fact that the accumulation of solid feces not only stretches, but also weakens the walls of the rectum. As a result, the constant attempts to defecate, which the pet makes to release the accumulated stool, lead to rectal prolapse.

Other causes that lead to rectal prolapse in an animal:

Helminthic infestations . The worms and the toxins they release irritate the mucous membranes. They provoke pushing and strong tension of the muscle layer of the anal sphincter, as a result of which they weaken and cannot hold the rectum.
Diseases of the large intestine . The most common of these are colitis and proctitis. They lead to intestinal damage, weakening of the whole organism, and in some cases – to the prolapse of the rectal area: in whole or in part.
Incorrect power supply . Feeding a pet exclusively with dry, low-quality food and a violation of the drinking regime leads to damage to the mucous membrane and prolapse of the rectum.
Injury .Severe damage to the anal sphincter muscles, improper rectal administration of drugs, or the use of irritating drugs can also cause rectal prolapse in cats, and in the most severe forms (bleeding or ulceration).
Diseases of the urinary system . These include urolithiasis (Urolithiasis) and cystitis. Without timely treatment, they lead to complications, one of which is complete prolapse of the rectum, including tissue death.
Other reasons . Other factors can also lead to the development of rectal prolapse in a cat. For example, inflammation of the soft tissues surrounding the anus, inflammation of the bladder, enlargement of the prostate gland, difficult labor, etc.

The main risk group includes kittens (up to 12 months), as well as adult cats (over 8-10 years). However, no genetic predisposition to this disease has been identified. If you notice signs of rectal prolapse in your pet, then seek veterinary help immediately!

Signs of rectal prolapse

The first thing that indicates the development of the disease is a slight protrusion (protrusion) of the mucous membrane of the large intestine .Depending on the severity of the condition, this protrusion is observed constantly or only after a bowel movement. In size, it can be from several millimeters to several centimeters.

Other characteristic signs that should alert you:

Frequent urge to defecate,
painful sensations when defecating or urinating,
bleeding of mucous membranes,
active licking of the damaged area,
Visually noticeable feces (outside the act of defecation), the color of which can be from pink to black, depending on the age of excretion.

Additional signs (eg, deterioration of general well-being, refusal to eat) may indicate rectal prolapse. However, how they will manifest themselves depends on the cause of the disease. For example, if the prolapse is caused by inflammation of the bladder, then frequent and painful urination is added to the additional symptoms.

Forecast

Feline rectal prolapse can be complete or partial. The latter often goes away on its own, therefore, with its development, the prognosis is often favorable.However, with complete prolapse of the rectum without manual (manual) reduction or amputation of the prolapsed area, the prognosis is poor.

Without treatment, rectal prolapse leads to damage to the intestinal mucosa and its death. However, the most dangerous thing is secondary blood poisoning (sepsis). Without timely treatment, rectal prolapse can be fatal!

Diagnosis of the disease

A simple examination may not be enough to make a diagnosis.This is due to the fact that protrusion is possible in two diseases – ileo-colon intussusception and rectal prolapse. To differentiate between them and to prescribe treatment, the veterinarian uses a probe. It is placed between the anus and the fallen masses, so a steady resistance is felt when the rectum prolapses.

The next step is to identify the cause of the disease. To find it, a specialist uses various diagnostic methods (ultrasound and X-ray examination, analysis of feces for the presence of helminths in it, blood tests, etc.).). Then the doctor chooses the most effective method of treatment, depending on some parameters:

degree of prolapse,
duration of illness,
causes of rectal prolapse,

90,017 general condition of the pet.

How is rectal prolapse treated in cats?

Manual (manual) reduction . It is performed under anesthesia and is indicated in acute cases of prolapse, provided that the soft tissues in the anal area are not damaged.The first thing that a specialist does is treat the prolapsed rectal area with various agents (for example, saline) in order to reduce the volume of prolapse and facilitate the process. After the procedure, a purse-string suture is applied around the anus. Its diameter is determined individually, depending on the likelihood of recurrence. During the entire rehabilitation period (7-10 days), the cat is recommended dietary food.

Amputation of the prolapsed rectum. This method of treatment is indicated for chronic prolapse, as well as in cases where manual (manual) reduction is not possible.The operation is performed under general anesthesia, while the non-viable part of the rectum is removed and anastomosis is applied. If necessary, a purse-string suture is applied for 1-2 days to prevent recurrent loss. After surgery, the cat is given laxatives to make it easier to have a bowel movement.

Colopexy . It is indicated for relapses, i.e. in cases where the previous methods of treatment did not help in solving the problem. With colopexy, the colon is sutured to the abdominal cavity, so even a slight displacement of the large intestine is excluded.The operation is performed using different methods: laparoscopic or open (through the abdominal cavity). In terms of effectiveness, they are the same, so the choice remains with the veterinarian performing the surgery.

However, treatment in a veterinary clinic in Moscow includes not only reduction or removal of a prolapsed rectum, but also elimination of the cause of prolapse. For example, if the disease is caused by a helminthic invasion, then an anthelmintic treatment is prescribed. This allows not only to reduce the risk of recurrence, but also to restore the general well-being of the pet.

How to prevent the development of rectal prolapse?

To prevent rectal prolapse in cats, follow the simple guidelines . The first thing to do is to ensure a balanced diet that will not lead to persistent constipation or, conversely, to diarrhea. On the recommendation of a veterinarian, your pet can be given vitamins that improve digestion and probiotics.

Other tips to help avoid prolapse:

regularly perform anthelminthic treatment,
follow the routine vaccination schedule,
Provide timely treatment of primary diseases (prostatitis, cystitis, urolithiasis, etc.)),
Prevent the animal from injuring itself and swallowing various foreign objects.

Rectal prolapse is a dangerous disease that, without timely treatment by a veterinarian in Moscow, can cost a pet a life. If you notice rectal prolapse in your cat, seek help as soon as possible. A specialist will examine the pet, quickly carry out all the necessary research and select an effective method of treatment.

Symptoms of rectal prolapse

At an early stage, the prolapse of the rectum is almost not manifested in any way. Over time, as it progresses, the disease manifests itself with the following symptoms:

Pain during bowel movements
Inability to empty the bowels without excessive straining
Feeling of incomplete bowel movement
Inability to go to the toilet without laxatives or enemas
Frequent false urge to empty the bowels
Feeling of a foreign body in the anus
Mucous or bloody discharge from the anus (if there were rectal injuries)

Please note: if you already have at least one of these symptoms, then the prolapse of the rectum progresses and sooner or later will lead to even more serious complications (for example, ulcers or infections) that are very difficult to treat.
To avoid this, it is important to diagnose diseases in time and take the necessary measures. This can only be done by an experienced doctor. Therefore, do not self-medicate, which will still not help you. Make an appointment with our specialists.

Reasons for prolapse of the rectum

Rectal prolapse is caused by a weakening of the pelvic floor muscles. As a rule, this weakening is based on several reasons, among which may be:

Congenital pelvic muscle failure
Age-related weakening of the pelvic floor muscles
Frequent and prolonged constipation
Serious childbirth with injuries
Delivery too long
Late labor
The habit of sitting on the toilet for a long time, which has been formed since childhood
Strong pushing during bowel movement
Severe cough due to various diseases of the lungs and upper respiratory tract: (bronchitis, pneumonia, flu)
Obesity or sudden weight loss
Heavy physical labor associated with lifting weights

Degrees of rectal prolapse

I degree: , as a rule, there are no unpleasant sensations, but the examination can reveal a slight protrusion of the rectum
II degree: there are already difficulties, pain and discomfort during bowel emptying, rectal prolapse is visually observed
III degree: in addition to pain, discomfort and difficulties during bowel movements, painful urge to empty the intestines, a feeling of incomplete emptying occur, bleeding from the rectum occurs, anal fissures and mucosal ulcers develop

Complications and consequences of prolapse of the rectum

Over time, if the prolapse of the rectum is not treated, serious complications will surely occur, among which the most common are:

Inflammation of the rectum (proctitis)
Heavy and painful bleeding from the rectum
Deep anal fissures
Fistulas
Anemia (occurs due to frequent and subtle blood loss as a result of microtraumas of the rectum)

Prevention of rectal prolapse

A healthy lifestyle, professional management of pregnancy and competent delivery – all this greatly reduces the risk of prolapse of the rectum and other organs.
A balanced diet is essential: eat more high-fiber foods (fruits, vegetables, herbs), do not overdo fried, smoked, too hot or spicy foods, do not eat processed foods and do not snack on the run.
It is important to timely treat diseases of the lungs and upper respiratory tract that cause severe cough, as well as diseases of the gastrointestinal tract, among which constipation is the leading one.
It is equally important not to bother with excessive physical exertion, which over the years leads to a weakening of the pelvic muscles and, as a result, prolapse of internal organs.

Diagnosis of prolapse of the rectum

When prolapse of the rectum and other organs (uterus, vagina, bladder), it is important to understand what led to the weakening of the pelvic muscles, determine the degree of prolapse, assess the condition and function of adjacent organs, exclude infections and inflammation. This is why comprehensive diagnostics are important.

History: when there was pain in the abdomen and discomfort during bowel movement, a feeling of incomplete emptying, constipation and bleeding from the rectum, what diseases are there, whether there were any operations, whether anyone from close relatives suffered from rectocele or other diseases of the gastrointestinal tract
Palpation of the abdomen and rectum

Laboratory diagnostics:

Blood tests (biochemical and clinical) – help to identify anemia that often accompanies rectal prolapse, inflammatory reactions, liver, pancreas and kidney diseases
Fecal occult blood test – if there is suspicion of occult bleeding in the intestine
Coprogram – analysis of feces, which helps to assess the efficiency of the bowel

Instrumental diagnostics:

Dynamic defectoproctography (X-ray of the intestine during emptying) – helps to identify possible damage to the musculo-ligamentous apparatus
Sigmoidoscopy (visual examination of the rectum and some parts of the sigmoid colon using an endoscope) – helps to accurately diagnose prolapse of the rectum, even at the earliest stage
Colonoscopy – helps to identify pathology of the colon
CT – helps to assess the condition of the liver, pancreas, bladder, kidneys and identify possible complications
Ultrasound of the abdominal cavity and small pelvis – helps to assess the condition of the gallbladder, biliary tract, pancreas, kidneys, intestines and determine the retention of feces in the intestine

To rule out or confirm prolapse of other organs (uterus, vagina and bladder), your doctor will refer you to a gynecologist and urologist.

Treatment of rectal prolapse

Many people turn a blind eye to the symptoms of rectal prolapse and get used to living with them. This is a dangerous attitude, fraught with big problems in the future: after all, if the prolapse began, it will only progress and worsen and sooner or later will lead to complications that will irreversibly spoil your health and quality of life.
Rectal prolapse must be treated. How exactly – your doctor will determine based on the results of a thorough preliminary diagnosis.
Treatment can be conservative and operative. The operation is prescribed when other – non-operative – methods of treatment do not give a result.

Conservative treatment

Bandage
A special device that keeps the pelvic organs, intestines and rectum in their normal anatomical position. The bandage is selected by the attending physician based on the degree of omission and your individual characteristics. It is very important to use the bandage correctly: it should only be put on and off while lying down.
Therapeutic massage
Performed by a specialist only. Helps strengthen the pelvic floor muscles and, as a result, return the rectum to its normal position.

Special gymnastics
Restores the tone of the pelvic muscles and returns the normal position to the lowered organs. It is carried out at home. It is important to receive training from a specialist who will show you how to do the exercises.
Diet
Avoid foods that cause gas and constipation.The diet that is right for you will be selected by a nutritionist, to whom your doctor will refer you.
Medicines
It is important not only to remove the cause of the disease, but also to remove unpleasant symptoms that spoil the quality of life. Various painkillers and laxatives will help with this, which the attending physician will select individually based on the intensity of their manifestation, your intolerance to certain drugs and the general condition of your body.
When these treatments fail and your condition worsens, your doctor will refer you to surgery to have the surgeons fix the rectum in the correct anatomical position.The technique of the operation is selected depending on the degree of prolapse, the presence or absence of prolapse of other organs, concomitant diseases, your general condition and a number of other factors.

Surgical treatment of rectal prolapse: why in the network of clinics “Stolitsa”?

An integrated approach

In order to understand what caused the weakening of the pelvic muscles in you, and to develop the correct tactics for surgical intervention, we conduct a comprehensive diagnosis, involve related specialists (urologist, gynecologist, nutritionist) to clarify the diagnosis and select the method of surgical intervention based on the degree of prolapse, pathologies of neighboring organs, your age and a number of other important factors.

Modern operating unit

Two operating theaters and an intensive care unit are equipped with premium high-tech surgical equipment, thanks to which we successfully perform various surgeries for the prolapse of the rectum and other organs and restore your health, regardless of the complexity of your case.

First-class surgeons

Even high-tech equipment without good surgeons is just apparatus. Over the years of successful practice, our specialists have performed a huge number of operations and helped hundreds of people return to full life.When contacting us, remember: we will thoroughly understand your situation, carry out the operation that is necessary for you, and help you recover.

Modern operations

High-tech surgical intervention using mesh implants is the most effective method of treating rectal prolapse.
Operations are carried out without general anesthesia, are practically pain-free and help to gently fix the rectovaginal septum and remove the protrusion of the rectum.
Modern fixing meshes (implants) that we use have a unique pattern, so that they can be fixed to the pelvic ligaments and reliably fix the rectovaginal septum.
Please note: implants are absolutely safe and do not cause the development of infections, as they are chemically inert in contact with body tissues.

Post-operation

After the operation, you will be transferred to a cozy 1- and 2-bed ward with everything you need, where it will be convenient and comfortable for you, and our specialists will closely monitor your condition.The rehabilitation period directly depends on the type of operation performed and varies from one day to several days.

Contraindications to surgical treatment

There are several conditions and pathologies in which the operation cannot be performed:

Progressive diseases of internal organs
Acute cardiovascular diseases
Various infectious diseases
Inflammatory diseases of the genital organs
Poor blood clotting
Sexually transmitted diseases
Tendency of tissues to excessive scarring
Progressive diabetes mellitus

How much surgical treatment is necessary and possible in your case will be determined by our specialists based on the results of preliminary diagnostics.