What are the signs of rectal prolapse. How is rectal prolapse diagnosed. What treatments are available for rectal prolapse. Can rectal prolapse be prevented. Who is at risk for developing rectal prolapse. When should you see a doctor about rectal prolapse symptoms. What complications can occur if rectal prolapse is left untreated.

Understanding Rectal Prolapse: Types and Symptoms

Rectal prolapse occurs when the rectum – the final section of the large intestine – drops down or protrudes from the anus. While not typically considered a medical emergency, this condition can significantly impact quality of life and worsen over time if left untreated.

There are three main types of rectal prolapse:

• External prolapse: The entire rectum extends outside the anus
• Mucosal prolapse: Only the rectal lining protrudes from the anus
• Internal prolapse: The rectum has begun to descend but remains inside the body

Recognizing the symptoms of rectal prolapse is crucial for early diagnosis and treatment. Common signs include:

• Feeling a bulge or mass protruding from the anus
• Sensation of sitting on a ball after bowel movements
• Visible red tissue outside the anal opening
• Pain or discomfort in the anal or rectal area
• Bleeding from the rectum
• Leakage of blood, stool, or mucus from the anus

Is rectal prolapse the same as hemorrhoids? While both conditions can cause similar symptoms, they are distinct. Hemorrhoids are swollen blood vessels in the anus or lower rectum, whereas rectal prolapse involves the actual descent of rectal tissue. A medical professional can accurately diagnose which condition you’re experiencing.

Causes and Risk Factors of Rectal Prolapse

Understanding the underlying causes and risk factors of rectal prolapse can help identify those at higher risk and potentially prevent its occurrence. Some common causes include:

• Chronic constipation or diarrhea
• Prolonged straining during bowel movements
• Weakening of muscles and ligaments in the rectal area due to aging
• Previous injury to the anal or hip area
• Nerve damage affecting muscle control
• Neurological conditions impacting the spinal cord

Several factors can increase an individual’s risk of developing rectal prolapse:

• Age: More common in adults over 50, especially women
• Gender: Women are more susceptible than men
• Chronic pelvic floor disorders
• Family history of rectal prolapse
• Chronic obstructive pulmonary disorder (COPD)
• Benign prostatic hypertrophy
• Congenital bowel disorders like Hirschsprung’s disease

How can you reduce your risk of rectal prolapse? While some risk factors are unavoidable, maintaining a healthy lifestyle, managing chronic conditions, and practicing proper bowel habits can help minimize the risk of developing this condition.

Diagnosing Rectal Prolapse: Medical Examinations and Tests

Accurate diagnosis of rectal prolapse is essential for determining the most appropriate treatment plan. Healthcare providers may employ various examination techniques and diagnostic tests to confirm the condition and assess its severity.

Physical Examination

The initial step in diagnosing rectal prolapse typically involves a physical examination. Your doctor may ask you to sit on a toilet and attempt a bowel movement, allowing them to observe any prolapse directly. While this may feel uncomfortable, it provides valuable information for an accurate diagnosis.

Advanced Diagnostic Tests

In some cases, additional tests may be necessary to confirm the diagnosis or evaluate related conditions. These may include:

• Anal electromyography (EMG): Assesses nerve function in the anal sphincter
• Anal manometry: Measures muscle strength in the rectum and anus
• Anal ultrasound: Examines the muscles and tissues of the anal area
• Pudendal nerve terminal motor latency test: Evaluates the nerves controlling bowel movements
• Proctography: X-ray videos of the rectum during defecation
• Colonoscopy: Examines the inside of the intestines for potential causes of prolapse
• Proctosigmoidoscopy: Similar to colonoscopy but focuses on the lower portion of the colon
• MRI: Provides detailed images of the pelvic organs

What information do these tests provide? These diagnostic procedures help healthcare providers determine the extent of the prolapse, identify any underlying causes, and assess the overall health of the rectal and pelvic area. This comprehensive evaluation guides the development of an effective treatment plan.

Treatment Options for Rectal Prolapse

The treatment of rectal prolapse aims to address the underlying causes, alleviate symptoms, and restore normal bowel function. The choice of treatment depends on various factors, including the severity of the prolapse, the patient’s overall health, and their personal preferences.

Non-Surgical Approaches

In some cases, especially for mild or early-stage prolapse, non-surgical interventions may be recommended:

• Dietary modifications to improve bowel habits
• Pelvic floor exercises to strengthen supporting muscles
• Stool softeners or laxatives to ease bowel movements
• Manual reduction of the prolapse (pushing the rectum back in)

Surgical Treatments

For more severe cases or when conservative measures prove ineffective, surgical intervention may be necessary. Common surgical procedures include:

• Abdominal rectopexy: Attaching the rectum to the sacrum (lower backbone)
• Perineal rectosigmoidectomy: Removing the prolapsed portion of the rectum
• Delorme’s procedure: Removing only the inner lining of the prolapsed rectum
• Altemeier procedure: Removing the prolapsed rectum and rejoining the remaining tissue

Can rectal prolapse be cured completely? With appropriate treatment, many patients experience significant improvement or complete resolution of their symptoms. However, the success of treatment depends on various factors, including the underlying cause, the extent of the prolapse, and the patient’s overall health.

Preventing Rectal Prolapse: Lifestyle Modifications and Risk Reduction

While not all cases of rectal prolapse can be prevented, certain lifestyle changes and preventive measures can help reduce the risk of developing this condition or prevent its recurrence after treatment.

Dietary Modifications

Maintaining a healthy diet plays a crucial role in preventing rectal prolapse. Consider the following dietary recommendations:

• Increase fiber intake through fruits, vegetables, and whole grains
• Stay hydrated by drinking plenty of water throughout the day
• Limit consumption of processed foods and those low in fiber
• Consider fiber supplements if recommended by your healthcare provider

Proper Bowel Habits

Developing healthy bowel habits can significantly reduce the risk of rectal prolapse:

• Avoid straining during bowel movements
• Don’t ignore the urge to have a bowel movement
• Limit time spent on the toilet
• Use proper posture when having a bowel movement

Pelvic Floor Exercises

Strengthening the pelvic floor muscles can help support the rectum and prevent prolapse:

• Practice Kegel exercises regularly
• Consult a physical therapist specializing in pelvic floor rehabilitation
• Incorporate core-strengthening exercises into your fitness routine

How effective are these preventive measures? While they may not guarantee prevention in all cases, these lifestyle modifications can significantly reduce the risk of developing rectal prolapse and improve overall digestive health.

Living with Rectal Prolapse: Coping Strategies and Quality of Life

Dealing with rectal prolapse can be challenging, both physically and emotionally. However, there are several strategies to help manage the condition and maintain a good quality of life:

Emotional Well-being

• Seek support from friends, family, or support groups
• Consider counseling to address any emotional distress
• Practice stress-reduction techniques like meditation or yoga

Daily Management

Implementing certain practices in your daily routine can help manage symptoms:

• Use moist wipes instead of dry toilet paper to reduce irritation
• Wear comfortable, breathable clothing
• Plan activities around your bowel routine when possible
• Carry a small kit with wipes and clean underwear for emergencies

Communication with Healthcare Providers

Maintaining open communication with your healthcare team is crucial:

• Keep track of your symptoms and any changes
• Don’t hesitate to ask questions or express concerns
• Follow up regularly with your doctor, even after treatment

How can you maintain a positive outlook while dealing with rectal prolapse? Focus on the aspects of your life you can control, stay connected with your support network, and remember that with proper treatment and management, many people with rectal prolapse lead fulfilling lives.

Complications and Long-term Outlook of Rectal Prolapse

Understanding the potential complications and long-term prognosis of rectal prolapse is essential for patients and their caregivers. While many cases can be successfully treated, untreated or severe prolapse may lead to various complications:

Potential Complications

• Chronic constipation or fecal incontinence
• Ulceration or bleeding of the prolapsed tissue
• Strangulation of the prolapsed rectum, leading to tissue death
• Recurrence of prolapse after treatment
• Increased risk of rectal cancer (in long-standing cases)

Long-term Prognosis

The long-term outlook for patients with rectal prolapse varies depending on several factors:

• Severity of the prolapse at the time of diagnosis
• Effectiveness of the chosen treatment method
• Patient’s overall health and adherence to post-treatment recommendations
• Presence of underlying conditions contributing to the prolapse

What is the success rate of rectal prolapse treatment? While success rates vary depending on the treatment method and individual factors, many patients experience significant improvement or complete resolution of symptoms with appropriate treatment. However, some may require ongoing management or additional interventions.

Follow-up Care

Regular follow-up care is crucial for monitoring the condition and preventing recurrence:

• Attend scheduled follow-up appointments with your healthcare provider
• Report any new or worsening symptoms promptly
• Continue practicing preventive measures and maintaining a healthy lifestyle
• Consider periodic screening for related conditions, as recommended by your doctor

By understanding the potential complications and long-term outlook of rectal prolapse, patients can make informed decisions about their treatment and take proactive steps to manage their condition effectively.

Rectal Prolapse: Symptoms, Causes, Treatment, Surgery

What Is Rectal Prolapse?

Prolapse is when any body part slips or falls down from its normal position. Rectal prolapse is when your rectum — the last section of your large intestine — drops down or slides out of your anus. While that may sound scary, it’s typically not considered a medical emergency. However, the longer you have the condition, the worse it can get. Living with rectal prolapse can cause embarrassment and affect your quality of life.

If you feel like something just isn’t right when you go to the bathroom, or try to poop, you shouldn’t ignore it or make light of it. Your doctor can diagnose rectal prolapse and suggest treatment to fix it.

Types of Rectal Prolapse

There are three types of prolapse:

• External prolapse: The entire rectum sticks out of your anus.
• Mucosal prolapse: Part of the rectal lining pokes out of your anus.
• Internal prolapse: The rectum has started to drop but is not yet sticking out of your anus.

Rectal Prolapse Symptoms

If you feel like you’re sitting on a ball after pooping, or if you notice that you have something sticking out of the opening (your anus) where you poop, you could have rectal prolapse.

Typically, you’ll first experience rectal prolapse after you have a bowel movement. The first time, or first few times, the rectum may return inside on its own. Later, you may feel like something has fallen out of your body, or you just feel something down there that isn’t normal. In those cases, you may be able to push the rectum back in yourself.

Additional symptoms of rectal prolapse can include:

• Feeling a bulge outside your anus
• Seeing a red mass outside your anal opening
• Pain in the anus or rectum
• Bleeding from the rectum
• Leaking blood, poop, or mucus from the anus

Early on, rectal prolapse may look like hemorrhoids slipping out of your anal opening, but these are two different conditions. Hemorrhoids are swollen blood vessels in your anus or lower rectum that may cause itching, pain, and blood on the toilet paper when you wipe after you poop. Your doctor can diagnose whether you have rectal prolapse or hemorrhoids.

Rectal Prolapse Causes

A variety of things can cause the condition, including:

• Long-term history of diarrhea or constipation
• Long-term history of having to strain when you poop
• Old age, which weakens muscles and ligaments in the rectal area
• Previous injury to the anal or hip area
• Nerve damage that affects your muscles’ ability to tighten and loosen, which could be caused by pregnancy, vaginal childbirth complications, anal sphincter paralysis, or injury to your spine or back
• Neurological problems, such as spinal cord disease or spinal cord transection

Rectal Prolapse Risk Factors

More women develop rectal prolapse than men, especially women older than 50. In general, older people who have had a history of constipation or problems with their pelvic floor have a higher chance of having the problem.

Any of these health conditions could put you at higher risk for rectal prolapse:

• Chronic constipation
• Always have to strain to poop
• Lower back injury or disc disease
• Muscle weakness in your anus or pelvic floor
• Someone in your family also had rectal prolapse
• Parasitic infections like schistosomiasis
• Chronic obstructive pulmonary disorder (COPD)
• Benign prostatic hypertrophy
• Any injury or problems with ligaments that keep your rectum attached to the intestinal wall
• Congenital bowel disorders like Hirschsprung’s disease or neuronal intestinal dysplasia

Rectal Prolapse Diagnosis

Your doctor can do a rectal exam. While you may hesitate to do this, your doctor may ask you to sit on a toilet and poop or at least try to go. This is helpful because it allows your doctor to see the prolapse.

You may need some other, more advanced tests to diagnose rectal prolapse, especially if you have other related conditions:

• Anal electromyography (EMG):This test checks to see if nerve damage is causing your anal sphincter problems.
• Anal manometry: A thin tube is inserted into your rectum to test muscle strength.
• Anal ultrasound: A probe inserted into your anus and rectum is used to examine muscles and tissues.
• Pudendal nerve terminal motor latency test: It checks your pudendal nerves, which you use to control bowel movements.
• Proctography:X-ray videos of your rectum during a poop show how well it holds and releases feces.
• Colonoscopy: A long tube inserted into your rectum with a tiny camera at the end can show the inside of your intestines and look for any problems that may be causing your prolapse.
• Proctosigmoidoscopy:This test also uses a long tube with a camera on the end. It’s inserted deep into your intestines to look for inflammation, scarring, or a tumor.
• MRI: Imaging scan examines all of the organs in your pelvic area.

Rectal Prolapse Treatment

The most common treatment for rectal prolapse is surgery to put the rectum back in place, and there are several types. The kind of surgery your doctor recommends will depend on factors such as your overall health, age, and how serious your condition is. The two most common types of surgery:

• Abdominal: This type of surgery can be done either with a large incision or using laparoscopy, which uses small cuts and a camera attached to an instrument so the surgeon can see what needs to be done and if there are any additional issues that need to be fixed.
• Perineal: Also called rectal repair, this approach may be used if you are older or have other medical problems. This type of surgery can involve the inner lining of the rectum or the portion of the rectum extending out of the anus.

If your rectal prolapse is very minor and it is caught early, your doctor might have you treat it by taking stool softeners to make it easier to go to the bathroom and by pushing the rectum’s tissue back up the anus by hand. But, typically, you will eventually need to have surgery to fix rectal prolapse.

Rectal Prolapse Prevention

To prevent rectal prolapse, try not to strain when you poop. Try these tips to ease or prevent constipation that leads to straining:

• Get more fiber in your diet. Aim for at least five servings of fruits and veggies each day.
• Drink 6 to 8 glasses of water a day.
• Get regular exercise.
• Keep your weight at a healthy level or lose weight if you need to.
• If you have constipation often, talk to your doctor. They may direct you to take a stool softener or laxative.

Avoid heavy lifting, as this could put pressure on your bowel muscles.

Rectal Prolapse Complications

Rectal prolapse, if it’s not treated, could lead to these complications:

• Rectal damage like ulceration or bleeding
• Your rectum can’t be manually pushed back up inside you
• Strangulation, or the blood supply in your rectum is reduced
• Gangrene, or the strangulated rectal tissue decays and dies

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?

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.

Rectal Prolapse | Johns Hopkins Medicine

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

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

Causes

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

Symptoms

Symptoms of rectal prolapse include:

• Feeling a bulge after coughing, sneezing, or lifting

• Having mucous discharge in your stool

• Pain and rectal bleeding

• Fecal incontinence

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

• Feeling pressure in your rectum

• Being constipated

• Having anal pain, bleeding, or itching

Risk factors

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

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

• A long history of constipation

• Straining to have bowel movements

• Chronic diarrhea

• Laxative abuse

• Childbirth

• Spinal cord problems or previous stroke

• Cystic fibrosis

• Aging or dementia

Diagnosis

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

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

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

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

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

Treatment

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

Types of surgery include:

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

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

• Repair done by combining these techniques

Complications

These are the two main types of complications:

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

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

When to call the healthcare provider

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

• Fever

• Chills

• Redness

• Swelling

• Bleeding

• Discharge

• Constipation

• Fecal Incontinence

Managing rectal prolapse

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

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

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

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

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

• Drink 6 to 8 glasses of water every day.

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

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

Rectal prolapse – Better Health Channel

The rectum is the last 20 cm or so of the large bowel. It is the temporary storage area for bowel motions. Rectal prolapse occurs when the rectum turns itself inside out and comes out through the anus. Without treatment, the rectum will eventually need to be pushed back in manually.

Women are six times more likely to suffer rectal prolapse than men. Children of both sexes under the age of three years are also commonly affected by rectal prolapse, although the prolapse tends to resolve by itself without the need for surgery.

In the early stages of rectal prolapse, a portion of the rectum slips out while passing a bowel motion, but it goes back inside by itself.

Symptoms of rectal prolapse

The symptoms of rectal prolapse depend on the severity, but can include:

• Pain and discomfort felt deep within the lower abdomen
• Blood and mucus from the anus
• The feeling of constipation, or that the rectum is never completely emptied after passing a motion
• Difficulties passing a bowel motion
• Protrusion of the rectum through the anus
• The need to use huge quantities of toilet paper to clean up following a bowel motion
• Leakage of liquefied faeces, particularly following a bowel motion
• Faecal incontinence, or reduced ability to control the bowels.

Types of rectal prolapse

Rectal prolapse is graded according to its severity, including:

• Internal prolapse – the rectum has prolapsed, but not so far as to slip through the anus. This is also known as incomplete prolapse
• Mucosal prolapse – the interior lining of the rectum protrudes through the anus
• External prolapse – the entire thickness of the rectum protrudes through the anus. This is also known as complete or full-thickness prolapse.

Causes of rectal prolapse

The exact cause of rectal prolapse is unknown, but risk factors include:

• Chronic constipation
• Straining to pass bowel motions
• Weakened pelvic floor muscles
• Weakened anal sphincter muscles
• Weakening of the muscles associated with ageing, since rectal prolapse is more common in people aged 65 years and over
• Genetic susceptibility, since it appears that some people with rectal prolapse have a blood relative with the same condition
• Parasitic infection, such as schistosomiasis – very rare in Australia
• Any condition that chronically increases pressure within the abdomen, such as benign prostatic hypertrophy, or chronic obstructive pulmonary disease (COPD)
• Structural problems with the ligaments that tether the rectum to its surrounds
• Congenital problems of the bowel, such as Hirschsprung’s disease or neuronal intestinal dysplasia
• Prior trauma to the lower back
• Disc disease in the lower back.

Complications of rectal prolapse

Complications of rectal prolapse include:

• Risk of damage to the rectum, such as ulceration and bleeding
• Incarceration – the rectum can’t be manually pushed back inside the body
• Strangulation of the rectum – the blood supply is reduced
• Death and decay (gangrene) of the strangulated section of the rectum.

Diagnosis of rectal prolapse

Rectal prolapse is diagnosed by examination. In cases where the rectum goes back inside by itself after passing a bowel motion, the person may have to bear down during examination by the doctor to show the prolapse in order to confirm the diagnosis.

In cases of suspected internal prolapse, diagnostic tests may include ultrasound, special x-rays and measurement of the anorectal muscle activity (anorectal manometry). If the person has experienced rectal bleeding, the doctor may want to do a number of tests to check for other conditions such as bowel cancer.

About 11 per cent of children with rectal prolapse have cystic fibrosis, so it is important to test young people for this condition too.

Treatment for rectal prolapse

Treatment depends on many individual factors, such as the age of the person, the severity of the prolapse, and whether or not other pelvic abnormalities are present (such as prolapsed bladder). Treatment options can include:

• Diet and lifestyle changes to treat chronic constipation – for example, more fruit, vegetables and wholegrain foods, increased fluid intake and regular exercise. This option is often all that’s needed to successfully treat rectal prolapse in young children
• Securing the structures in place with surgical rubber bands – in cases of mucosal prolapse
• Surgery.

Surgery for rectal prolapse

Surgery is sometimes used to secure the rectum into place. It can be performed through the person’s abdomen or via their anus. One operation involves tethering the rectum to the central bone of the pelvis (sacrum). Another operation is to remove the prolapsed part of the rectum and to rejoin the bowel to restore near-normal bowel function.

Although surgery through the abdomen may give better long-term results, older people may be advised to undergo surgical correction via the anus, since it is easier to recover from this procedure.

Before surgery for rectal prolapse

The day before surgery, you will be asked to fast, and may need to drink a special preparation to help flush out your bowels. Once you are in hospital, the anaesthetist will visit you to see what sort of anaesthetic is best for you. You may be given medication in the hours before the operation to prepare you for anaesthesia and make you feel drowsy.

Rectal prolapse operation procedure

The various types of surgery include:

• Laparotomy (open abdominal surgery) – the surgeon uses a single, large incision (cut) in the abdomen. Then the surgeon carefully moves aside the overlying organs. To stop the rectum prolapsing, it is lifted, pulled straight and stitched directly to the inner surface of the sacrum (central bone of the pelvis). Sometimes, a short length of bowel may be removed
• Laparoscopy (keyhole abdominal surgery) – laparoscopy may be possible in some cases. This involves inserting slender instruments through a number of small incisions in the abdomen. Recovery time following laparoscopy is usually quicker than open surgery
• Anal surgery – under anaesthesia, the surgeon gently pulls out the prolapsed bowel through the anus. The prolapsed section of bowel is usually removed and the structural damage repaired. The bowel is rejoined and returned back through the anus to restore normal bowel function and appearance.

Other forms of treatment for rectal prolapse

Surgery is the best option for severe rectal prolapse. Other possible forms of treatment may include:

• Lifestyle changes – including high-fibre diet, drinking plenty of water and getting regular exercise
• Change to toileting habits – such as not straining when trying to pass a bowel motion. This may require using fibre supplements or laxatives.

After your operation for rectal prolapse or rectocele, things you can expect include:

• Hospital staff will observe and note your temperature, pulse, breathing and blood pressure.
• You will have an intravenous fluid line in your arm to replace fluids in your body.
• You will receive pain-relieving medications. Tell your nurse if you need more pain relief.
• You may have a catheter to drain off urine for the next day or so, or until you can empty your bladder by yourself.
• If you have a vaginal pack, this will be taken out later the same day or the day after surgery.
• You may be in hospital for three to six days following surgery.
• You will need to make follow-up appointments with your doctor.

Complications of surgery for rectal prolapse

Possible complications of surgery include:

• Allergic reaction to the anaesthetic
• Haemorrhage
• Infection
• Injury to nearby nerves or blood vessels
• Damage to other pelvic organs, such as the bladder or rectum
• Death (necrosis) of the rectal wall
• Recurrence of the rectal prolapse.

Taking care of yourself at home after surgery for rectal prolapse

Be guided by your doctor, but general suggestions include:

• Rest as much as you can.
• Avoid heavy lifting or straining for a few weeks.
• Don’t strain on the toilet.
• Take measures to prevent constipation, such as eating high-fibre foods and drinking plenty of water.
• After rectocele surgery, expect bloody vaginal discharge for about four weeks.
• Contact your doctor if you experience any unusual symptoms, such as difficulties with urination, heavy bleeding, fever, or signs of infection around the wound sites.
• You can expect to return to work around six weeks after surgery.
• Attend follow-up appointments with your surgeon.

Long-term outlook after surgery for rectal prolapse

While surgery through the abdomen gives better results, older people may be advised to undergo surgical correction of rectal prolapse via the anus, since this procedure is less stressful on the body.

Surgery gives good results in most cases of rectal prolapse, but some people may find that symptoms such as constipation or the inability to completely empty the bowels continue.

Unfortunately for women with rectocele, the problem will recur after surgery in about 10 per cent of cases.

Where to get help

• Your doctor
• Colorectal or general surgeon

Things to remember

• We do not know the exact cause of rectal prolapse, but risk factors include chronic constipation, straining to pass bowel motions, and weakened pelvic floor muscles.
• Treatment includes surgery, performed through the abdomen or via the anus, to tether the rectum into place.
• A diet that successfully treats constipation is often all that’s needed to cure rectal prolapse in young children.

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: Causes, symptoms, and treatments

Rectal prolapse is when part of the rectum protrudes from the anus. The rectum is the last part of the large intestine and is where feces is stored before being passed.

Prolapse occurs when the rectum becomes unattached inside the body and comes out through the anus, effectively turning itself inside out.

Rectal prolapse is a relatively rare condition, with the American Society of Colon and Rectal Surgeons estimating that it affects less than 3 in every 100,000 people.

Fast facts on rectal prolapse:

• A rectal prolapse tends to become noticeable gradually over time.
• Often it is associated with weak muscles in the pelvis.
• There can be complications if it is not treated promptly and properly.
• Treatment will depend on age, general health, and the cause of the prolapse.

There are three types of rectal prolapse:

• Full-thickness: The full thickness of the wall of the rectum sticks out through the anus. This is the most common type of rectal prolapse. There can be a partial or complete protrusion.
• Mucosal: Only the lining of the anus (known as the mucosa) sticks out through the anus.
• Internal: The rectum folds in on itself but does not stick out through the anus.

There is a range of risk factors and causes associated with rectal prolapse, although doctors do not fully understand why some people get it.

It can be triggered by a variety of things including:

There are also some neurological conditions that affect the nerves associated with rectal prolapse:

Rectal prolapse is more common in adults than children, and it is particularly prevalent in women aged 50 years or older, who are six times more likely to be affected than men.

Most women who have rectal prolapse are in their 60s, while most men are aged 40 or younger.

In the case of older women, rectal prolapse will often occur at the same time as a prolapsed uterus or bladder. This is because of general weakness in the pelvic floor muscles.

Share on PinterestA prolapsed rectum may cause a number of symptoms, inluding constipation and bleeding from the rectum.

At first, the person might only notice a lump or swelling coming out of their anus when they have a bowel movement.

Initially, the person may be able to push the rectal prolapse back in. Over time, however, the prolapse is likely to protrude permanently, and a person will be unable to push the prolapse back.

As time goes on, a rectal prolapse may happen when a person coughs, sneezes, or stands up. Some people with a rectal prolapse have described it as like “sitting on a ball.”

Some people may experience an internal rectal prolapse, which is different in that the prolapse will not protrude. However, the person may feel as if they have not passed everything during a bowel movement.

Other symptoms of a rectal prolapse include:

• difficulty controlling bowel movements, which occurs in around 50 to 75 percent of cases
• bright red blood coming out of the rectum
• discomfort
• constipation, present in about 25 to 50 percent of people who have a rectal prolapse

Complications include:

• Strangulated prolapse: This occurs when part of rectum becomes trapped and cuts off the blood supply, causing tissue to die. This can develop gangrene, and the area will turn black and drop off. It is rare and requires surgery.
• Solitary rectal ulcer syndrome: Present in mucosal prolapse, ulcers can develop on the part of the rectum sticking out. This complication often requires surgery.
• Recurring prolapse: People who have surgery for rectal prolapse may have another prolapse at some point in the future.

Although a rectal prolapse is not often defined as an emergency medical problem, it can be uncomfortable, embarrassing, and have a significant adverse effect on the person’s mental and physical life.

Therefore it is essential for anyone who has noticed any signs or symptoms of rectal prolapse to see a doctor as soon as possible.

The longer a person puts off receiving treatment for rectal prolapse the greater chance of permanent problems, such as incontinence and nerve damage.

In order to diagnose a rectal prolapse, the doctor will look at the person’s medical history, ask them about their symptoms, and conduct a physical examination.

A physical examination will involve the doctor inserting a lubricated, gloved finger into the rectum. While this can be uncomfortable and possibly embarrassing, it should not be painful and is very important for an accurate diagnosis.

Further tests may be required to clarify the diagnosis or rule out other processes, which include:

• Proctography: A type of X-ray that shows the rectum and anal canal during a bowel movement.
• Colonoscopy: A long, flexible, tube-like camera called a colonoscope is inserted to take a closer look at the large intestine and rectum.
• Endoanal ultrasound: A thin ultrasound probe looks at the muscles used to control the bowels

Share on PinterestIf constipation cannot be treated, surgery may be recommended for treating the rectal prolapse.

In the first instance, it is important to treat constipation. This might be achieved by eating plenty of foods that are high in fiber, such as fruit, vegetables, and wholegrains.

Bulking laxatives, which help a person have a bowel movement without straining, may also be recommended, as well as drinking plenty of water.

If that does not work, then surgery may be advised. The type of surgery will depend on a number of factors:

• type of prolapse
• the person’s age
• other medical problems
• whether the person is constipated or not

There are two general types of surgery for rectal prolapse:

• Abdominal: Entry through the belly through a cut or several cuts in the abdominal wall. Often used for full-thickness prolapse.
• Perineal: Involves cutting out the full thickness segment of the prolapsing rectum. Suitable for people who cannot have a general anesthetic.

Rectal prolapse can be confused with hemorrhoids, which are also known as piles. This is because both conditions affect the last section of the bowel and have similar symptoms.

While rectal prolapse affects the rectal wall, hemorrhoids affect the blood vessels in the anal canal. These two conditions require different treatment, so it is important to get the correct diagnosis.

There are some lifestyle changes people can make to try and avoid rectal prolapse, including:

• eating plenty of fiber
• drinking plenty of water
• exercising regularly
• avoiding excessive straining during a bowel movement

Most people make a full recovery after treatment for rectal prolapse and lead a normal life.

However, proper recovery is crucial and how long this will take will depend on the type of treatment.

Typically, people who have had surgery spend 3 to 5 days in the hospital after the operation, and most make a complete recovery within 3 months. After undergoing surgery for a rectal prolapse, people should avoid straining and heavy lifting for at least 6 months afterward.

90,000 Rectal prolapse – Coloproctology – Day (surgical) hospital – Departments

Rectal prolapse

Prolapse of the rectum is the exit to the outside of all its layers through the anus.

Prolapse of the rectum through the anus is often accompanied by constipation and the phenomenon of intestinal incontinence.

Rectal prolapse is a fairly common pathology and accounts for about 9% of all coloproctological diseases.

Symptoms

Complaints with rectal prolapse can be extremely varied. Patients note an admixture of blood in feces, constipation and difficulty in defecation, pain in the lower abdomen and perineum, false urge to defecate.

The course of the disease can be complicated by a number of conditions that require emergency medical care. First of all, this is an infringement of the prolapsed part of the rectum.

To the predisposing reasons of the development of the disease include a hereditary factor, peculiarities of the constitution of the body and the structure of the rectum, acquired degenerative changes in the muscles of the obturator apparatus and in the wall of the rectum.

Factors such as intestinal dysfunction (especially constipation), neurological changes (spinal cord injury, senile changes) also contribute to the development of the disease.

Diagnostics

Most often, patients come to the doctor with a “ready” diagnosis, but the appearance of the rectum from the anus during bowel movements, when straining or assuming an upright position is not the end, but only the beginning of the diagnosis.

In addition to a thorough clinical examination, which allows examining the prolapsed part of the rectum and assessing its shape, size and condition of the mucous membrane, patients need a thorough instrumental examination.

Colon endoscopic examination is necessary to detect tumors, diverticulosis and other pathological formations of the colon. An important element of diagnosis is X-ray examination, including irrigoscopy, defecography, which allows to determine the anatomical and functional changes in the colon.

Treatment

Treatment of this disease is only surgical and with its uncomplicated course is carried out in a planned manner only in specialized coloproctological hospitals.

90,000 Bowel prolapse (rectal prolapse)

The human intestine is characterized by a large length, as a rule, the length is equal to four meters. The final section of the intestine is represented by the rectum, in which feces are formed and removed to the outside. According to the norm, the rectum should be tightly attached and not displaced. However, a pathological condition can also be observed when the rectum extends beyond the anus.

This disease in medicine is characterized as rectal prolapse. With prolapse of the intestine, the lower part of the rectum stretches and falls out of the anal canal. As a result, patients may experience gas and fecal incontinence. The problem of intestinal prolapse can be faced by people of all ages, including children. The pathological segment in length corresponds to a scale of one to twenty centimeters.

Rectal prolapse can be internal (hidden) and external. The difference is that with internal prolapse, the rectum has already lost its position, but it has not yet fallen out.

Rectal prolapse can occur in a hernial form, implying that the anterior wall of the organ is displaced due to weakened pelvic muscles and high pressure in the abdominal cavity; as well as an invaginating form, which is possible when a segment of the sigmoid or rectum is pressed inside the mucous membrane of the anus.

The problem of rectal prolapse has been studied for over a hundred years, and during this time several classifications of this disease have been proposed.Among them, the most popular are the following loss classifications:

• The first degree assumes that the rectum is only prolapsed during a bowel movement.
• The second degree is characterized by prolapse of the rectum, not only during bowel movements, but during exercise.
• The third degree is associated with prolapse of the rectum while walking and even when the person is in an upright position.

Reasons for rectal prolapse

The main cause of rectal prolapse is intestinal intussusception.However, the provocateurs of the disease include the anatomical or genetic characteristics of the human body, which are expressed in weak muscles located in the pelvic floor and cannot cope with the load during defecation, and therefore gradually stretch; abnormal location of the uterus relative to the rectum; an elongated mesentery – a ligament connecting the back and front walls of the peritoneum; an elongated sigmoid colon; anomalies in the structure of the sacrum and coccyx; weak anal sphincter.

These reasons are associated with congenital pathologies, but they can also have a traumatic nature.The muscles of the pelvic floor and anal sphincter can weaken in a woman after a natural childbirth. Due to surgery, trauma to the anterior abdominal wall, perineum, rectum or anus, there is a change in the holding capacity of muscles and ligaments.

How to treat rectal prolapse in adults

To eliminate rectal prolapse, conservative and surgical treatment is performed. Patients are advised to follow a diet, perform a set of exercises to strengthen the muscles of the pelvic floor, anal sphincter and perineum in order to normalize the stool.In order for the disease not to progress, the patient completely excludes physical activity.

MEDICAL THERAPY

In the early stages of the disease, it is recommended to use conservative treatment, when the retraction of the rectum occurs independently. The goals of therapy are to reduce unpleasant symptoms; eliminate constipation and diarrhea; restore the tone of the anal sphincter and rectum.

The list of drugs is sparse.In most cases, drugs are prescribed to regulate the stool. We are talking about laxative suppositories or oral preparations (tablets, powders for preparing drinks. If the patient is in severe pain, it is necessary to start taking pain relievers.

SURGICAL INTERVENTION

Surgical treatment is used at 3 and 4 stages of rectal prolapse, as well as if conservative therapy has been ineffective. In medicine, it is customary to talk about several methods that fix the rectum in a physiologically correct position.All methods are differentiated into several groups, the difference of which is associated with the principle of influencing organs.

Consider the main methods of surgical treatment of rectal prolapse, presented by the methods of narrowing the anus; operations of rectopexy or attachment of the distal rectum to the fixed parts of the small pelvis; colopexy – transperitoneal fixation of the distal sigmoid colon to the immobile formations of the pelvis or the abdominal wall; operations aimed at strengthening the pelvic floor and perineum; partial or complete resection of the prolapsed intestine.

COMPLICATIONS

The most common complication of rectal prolapse is an entrapment of the prolapsed rectal area. If the treatment was started late, there is a risk of developing necrosis of the strangulated tissues.

PREVENTION

Prevention assumes that, firstly, it is necessary to eliminate heavy physical exertion and other factors that develop these pathologies, and, secondly, to normalize the work of the digestive tract.

Rectal prolapse

Rectal prolapse (rectal prolapse, pelvic floor prolapse)

Rectal prolapse is a condition where the rectum or part of it loses its proper position inside the body, becomes mobile, stretches and exits through the anus. 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 recurrence rate (re-emergence of the disease) – only about 15%. Complications in treatment usually arise 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 drop

Rectal prolapse and hemorrhoids

One of the common reasons why a patient does not consult a 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 improper treatment will never lead to the expected positive effect, and in some cases will exacerbate the problem.

Rectal prolapse. The causes of the disease.

What causes rectal prolapse?

• Anything that increases pressure inside the abdomen can cause rectal prolapse. Constipation, diarrhea, prostatic hyperplasia (straining when urinating), pregnancy and childbirth, persistent cough.
• Injury to the anus, pelvic floor muscles, 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.
• Mental health conditions associated with constipation such as: depression, anxiety, side effect of drugs used to treat mental disorders.

Rectal prolapse. Symptoms

• 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 (inserting the fingers of the bowel inward) 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 is noted 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.

Rectal prolapse.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 to 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 in a multidisciplinary manner, that is, jointly.

Rectal prolapse. Treatment.

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, our Clinic uses the following surgical techniques:

Abdominal operations (operations through the abdominal cavity)

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

2. The Kummel operation is fixation of the previously mobilized rectum to the promontory of the sacrum with interrupted sutures.

These operations can be performed as 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 that 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 surgery, it is important to control stool, avoid constipation and strong straining.

90,000 causes and symptoms, diagnosis, treatment and prevention

Reasons for rectal prolapse

This is not to say that the rectum falls out for any one reason.This is a rather complex pathophysiological process due to a number of factors. It has been established that an important role in the onset of the disease is played by the hereditary predisposition of the organism, the anatomical features of its structure, and chronic intestinal pathologies. Bowel prolapse is provoked by the following situations:

• Digestive disorders, accompanied by painful urge to defecate and spasm of the sphincter;
• constipation, interspersed with excessive straining emptying;
• prolonged stress of a physical and emotional nature;
• sharp and significant weight loss;
• trauma to the abdominal wall.

Types of rectal prolapse

There are three stages of the course of the disease, characterized by certain clinical signs:

• Stage 1 – bowel prolapse occurs only when the bowel is emptied, in most cases the site is pulled back on its own or can be painlessly repositioned by the patient;
• Stage 2 is accompanied by loss on the background of physical exertion, weight lifting, sports.May be accompanied by pinching pain;
• Stage 3 – the prolapse is permanent, occurs immediately after the patient gets to his feet.

How to recognize

The clinical picture of the disease is obvious: the patient feels discomfort in the anal area, finds there an “extra piece of the body”. However, there are symptoms that suggest pre-pathology. And if you pay attention to in time:

• persistent constipation alternating with no less persistent diarrhea;
• intermittent fecal incontinence, even in minimal doses;
• persistent pulling pains in the lumbar-gluteal region;
• gas incontinence;

Contact our clinic in a timely manner, we will certainly be able to prevent the acute development of the disease.If rectal prolapse is a fait accompli for you, the help of our specialists will be no less effective.

Rectal prolapse – treatment in Kemerovo

Rectal prolapse, or rectal prolapse, occurs at any age, although somewhat more frequently in older adults. Pathology does not threaten the patient’s life, but is often accompanied by rather unpleasant symptoms. The reliable causes of rectal prolapse are unknown. Frequent straining during bowel movements, childbirth and some features of the anatomy of the pelvis and intestines are most often noted among the probable factors contributing to prolapse.

Clinical signs

Most often, patients complain of protrusion of the rectum, which can occur only during bowel movements or physical exertion, in severe cases – with minimal exertion or simply in a standing position. Minor rectal bleeding may be troubling. Quite often, fecal incontinence is noted to one degree or another. Pain rarely worries – mainly with infringement and significant prolapse of the intestine.

Diagnostics

Diagnosis is based on characteristic clinical findings.To determine the degree of prolapse, it is necessary to examine the patient in a standing position and while straining. To rule out other diseases, additional diagnostic procedures are required, such as sigmoidoscopy or colonoscopy.

Rectum prolapse treatment

In the initial stages of the disease, treatment is conservative. In more severe cases, surgery is indicated. Given that the causes of the pathology are still unknown, there is no universal method of surgical correction.At the same time, many methods of surgical treatment have been developed, including:

• • excision of excess mucosal tissue

• • rectopexy – mobilization of the rectum and its fixation to the sacrum;

• • interventions aimed at strengthening the sphincter – various modifications of the Thirsh operation;

• • full-wall perineal rectal resection – Altmeyer’s operation.

These are just a few of the many techniques used for rectal prolapse. The choice of technique depends on the stage and characteristics of the pathology, age and other factors.

Rectum prolapse treatment in Kemerovo

You can get a proctologist’s consultation at the Krasnaya Gorka clinic. Our specialists are among the strongest in the city and have a huge number of positive reviews. Their rich practical experience and powerful diagnostic base of the clinic are a reliable way to solve any proctological problems.

Rectal prolapse treatment and symptoms

If you have more than 80% of the listed symptoms, we strongly recommend that you consult your doctor for advice.

The medical term “rectal prolapse” is used to denote a disease in which partial or complete displacement of a portion of the rectum outside the anus develops. Surprisingly, despite its extremely unpleasant clinical manifestations, this disease, even in the most severe forms, does not pose a threat to the patient’s life.

Pathology is rare and can affect patients of all age groups and both sexes. The length of the dropped segment can range from 20 to 200 millimeters or more. Modern medicine offers a wide range of methods aimed at its treatment, but, unfortunately, none of them is recognized by specialists as optimal.

Rectal prolapse occurs even in children between the ages of three and four. In this case, it is due to the specifics of the anatomical structure of the body of young patients.As for adults, in men this pathology develops much more often (almost 70%) than in the fair half of humanity. Sometimes this is associated with hard physical labor, which men are engaged in, and the structural features of the female pelvis, which better keeps the rectum in the correct position.

Etiology of rectal prolapse

The causes of the disease have not yet been established, but experts identify a number of factors that contribute to its development.They are divided into two large groups, which are presented in our table below:

Classification, symptoms, complications of rectal prolapse

Rectal prolapse in adults and children can appear suddenly, but in some cases, its development occurs gradually. The main symptom is the direct prolapse of a part of the intestine, which in the overwhelming majority of cases occurs during the act of defecation as a result of strong stress on the body. Pathology is characterized by such clinical manifestations as:

• fecal incontinence – up to eighty percent of cases;

90,047 stool disorders in the form of constipation – up to fifty percent of cases;

• insignificant bleeding;
• damage to the mucous membrane, accompanied by necrotization of its tissues.

Depending on the symptomatology, experts distinguish four stages of sphincter prolapse.

If the rectum has been adjusted incorrectly, roughly or at the wrong time, it can be infringed, which is accompanied by the following complications:

• rapidly developing edema;
• violation of blood supply to tissues and their death;
• displacement of the small intestine and the development of its acute obstruction and peritonitis.

Diagnosis of rectal prolapse

The proctologist diagnoses this pathological condition after the examination and the following instrumental diagnostic studies:

• manometry;
• rectoscopy;
• colonoscopy.

Examination reveals a dropped out tapered or cylindrical segment that is red or bluish in color and a hole located in the center.When you touch it, the mucous membrane bleeds and swells a little. After reduction, its appearance is restored. If during the examination it is not possible to identify the prolapse, the patient is asked to strain in order to identify the pathology.

Treatment of rectal prolapse

In order to solve the problem of prolapse, as a rule, surgical techniques are used, of which there are about a hundred. This is due to the fact that its reduction and the use of conservative therapy does not give a complete guarantee of cure.Conservative techniques are used in the first and second stages of the pathological condition, the duration of which does not exceed three years. In the process, sclerosing agents are used, as well as electrical stimulation of the circular muscles of the rectum and pelvic floor. As additional measures, the treatment of rectal prolapse is carried out at home using alternative methods, which must be coordinated with the proctologist.

It can be a set of special exercises aimed at normalizing muscle tissue, strengthening the muscles of the sphincter and perineum, as well as herbal medicine.The latter provides:

• reception of decoction from calamus root;
• Herbal baths from sage, knotweed, meadowsweet;
• quince lotions;
• chamomile steam baths;
• enemas with chamomile decoctions.

All of the above remedies help relieve symptoms, reduce inflammation, and reduce pain.

With regard to surgical treatment, depending on the clinical situation and the patient’s indications, it may be as follows:

• surgery for resection of a prolapsed segment – provides for its cutting in different ways;
• plastic correction of the anal canal – aimed at narrowing the anus;
• colon resection operation – gives good results in case of abnormally elongated sigmoid colon;
• rectopexy – provides for the fixation of the distal rectum to the spine or sacrum using a special mesh;
• combination of different techniques – depending on the patient’s indications, different types of resections, plastics and rectopexy can be used.

You can get diagnosed and treated for this pathology in Moscow in the network of clinics “Doctor near”. You can make an appointment by calling (+7 (495) 127-84-73) or by filling out the online form.

90,000 causes, symptoms and treatment in an article by phlebologist Khitaryan A.G.

Publication date February 19, 2018 Updated October 29, 2020

Rectal prolapse – partial or complete prolapse of the rectum outside the anus. The prolapse can be internal or in the form of intussusception of the rectum, which is understood as the introduction of the overlying part of the intestine into the underlying, but not exiting through the anus.In the overwhelming majority of cases, this disease is polietiologic, that is, there are several reasons for the occurrence, and their combination leads to loss. ^{[1] [2] [3]}

Among the reasons for development, it is customary to single out uncontrolled :

• heredity;
• violation of the formation of the intestinal wall;
• Violation of the formation of intestinal neuroinnervation.

And controlled:

• disorders of the muscular layer of the rectum;
• increased intra-abdominal pressure.

Often the disease is associated with the presence of long-term disorders of the act of defecation, traumatic or other acquired disorders of the innervation of the intestines, diseases of the respiratory system, accompanied by cough for a long time, severe physical activity, ^[4] as well as multiple pregnancies and various gynecological factors.

Often, the diagnosis of this disease is not difficult when it comes to external rectal prolapse.In this condition, patients complain of a feeling of a foreign body and incomplete emptying. A clear sign is the protrusion of the intestine through the anus. ^[5]

Also, patients in some cases note the need for manual reduction, after which relief comes. With internal intussusception, patients, as a rule, complain of difficulty in defecation, pain, mucus and blood, the need to insert fingers through the anus. 9058 friend, causing external or internal prolapse.

A classification of rectal prolapse has been created at the State Research Center for Clinical Research, which is used by most Russian specialists. ^{[7] [8]} This classification includes 3 stages depending on the conditions that led to the loss:

1st stage – during bowel movement;

2nd stage – during physical activity;

3rd stage – prolapse when walking.

In addition to the stages, this classification describes the degree of compensation of the muscular apparatus of the pelvic floor:

• compensation – spontaneous reduction by contraction of the muscular apparatus of the pelvic floor;
• decompensation – manual assistance is required for reduction.

In addition, this classification describes the degree of insufficiency of the anal sphincter:

1st degree – inability to retain intestinal gases;

2nd degree – inability to hold the liquid part of the stool

3rd degree – inability to hold any stool.

Foreign specialists adhere to Oxford classification , based on the results of X-ray examination.This classification distinguishes:

1. high rectal intussusception;

2. Low rectal intussusception;

3. high anal intussusception;

4.Low anal intussusception;

5. rectal prolapse. ^[9]

The most dangerous complication of rectal prolapse is infringement of the prolapsed section of the intestine. As a rule, with prolapse of the rectum, the infringement occurs when untimely reduction or when attempting a gross reduction.With infringement, the presence of increasing ischemia, the development of edema, is noted, and therefore it becomes more and more difficult to correct the fallen out area. In case of untimely appeal for specialized medical care, necrosis (necrosis) of the restrained area may occur.

Another complication of frequent prolapse of the rectum is the formation of solitary ulcers, which is associated with a violation of the trophism of the intestinal wall. Long-term ulcers can lead to bleeding, perforation, etc.

As a rule, the diagnosis of rectal prolapse is not particularly difficult. If, during rectal examination, no visible prolapse is detected, but the patient insists on prolapse, then he is placed in a knee-elbow position and asked to strain. In some cases, rectal prolapse can be mistaken for hemorrhoidal prolapse. The presence of the concentric nature of the folds will indicate prolapse of the rectum, while with the prolapse of hemorrhoids, the location of the folds will be radial.

The “gold standard” in the examination of coloproctological patients is X-ray defecography. ^{[10] [11]} This study is performed using an X-ray contrast agent, which fills the rectal lumen. The results of the study are evaluated based on the position of the contrasted colon from the pubococcygeal line at rest and during straining. Defecography also makes it possible to detect recto-, sigmo- and cystocele in patients.

In case of internal intussusception, sigmoidoscopy is important, the performance of which allows to reveal the presence of excessive folds of the mucous membrane and the filling of the rectoscope lumen with the intestinal wall. Sigmoidoscopy also allows you to identify ulcerative defects of the mucosa, the distinctive features of which is hyperemia of the mucosal area with a white coating. In about half of the patients, ulceration of the ulcer is noted, in a quarter – polypoid growths. ^{[12] [13]} It is important to perform video colonoscopy or irrigoscopy to detect colon tumors.

In case of rectal prolapse, and even more so internal intussusception, one of the leading methods of treatment is surgical, however, at the initial stages, the course of treatment should be started with conservative measures. The main directions of therapy are the normalization of the stool and passage of intestinal contents. To this end, the first step is a diet rich in fiber, as well as drinking plenty of fluids. The next step is the appointment of laxatives that increase the volume of fecal contents, as well as increased intestinal motility.Medicinal preparations of plantain seeds, for example, “Mucofalk”, have become widespread. The latter is prescribed 1 sachet or 1 teaspoon up to 5-6 times a day.

The methods of neurostimulation are also referred to as conservative methods of treating rectal prolapse. These methods include biofeedback therapy and tibial neuromodulation. This therapy is aimed at normalizing innervation. The biofeedback method is based on modeling the normal modes of operation of the muscles of the perineum and pelvic floor.The technique is a visualization of signals from sensors located in the rectum and on the skin of the perineum. The data is output to the monitor or as an audio signal. The patient, depending on the regimen or planned program, is able to control muscle contractions by volitional effort. Regular procedures allow to obtain a positive effect in 70% of patients with a violation of the innervation of the pelvic floor muscles. The tibial neuromodulation technique is to stimulate the tibial nerve to strengthen the muscles of the perineum and anal sphincter.Two electrodes are placed on the medial malleolus area. The impulses are given with periods of relaxation and tension.

Conservative methods lose their effectiveness with further development of the disease. In these cases, it is necessary to resort to surgical correction methods. All surgical interventions, depending on the access, are subdivided into perineal and transabdominal, which, in turn, can be divided into open and laparoscopic.

Despite the positive effect of conservative methods of treatment, the most effective is the use of surgical methods for correcting rectal prolapse. ^[14] At present, in the world practice, many methods of surgical treatment of rectal prolapse have been described. All described techniques can be divided depending on the approach used through the perineum or through the abdominal cavity. Perineal treatment options are more preferable for patients with existing severe concomitant pathology, since such operations are less traumatic. Along with less trauma, it is worth noting the high frequency of relapses, as well as postoperative complications.

Among the perineal interventions, there are such operations as:

• Delorma;
• Altmeera;
• Longo.

The essence of Delorm’s operation is that the mucous layer is dissected along the entire circumference two centimeters proximal to the scallop line. Further, after preparation, a drop-out area is excised from the underlying layer. The muscle layer is sutured in the longitudinal direction to create a roller, after which the mucous layer is sutured.The advantages of this operation are low trauma and a significant increase in the function of the anal sphincter, which leads to an improvement in the function of retaining fecal components. However, based on the data of various studies, the incidence of relapses is higher than with operations through the abdominal cavity, and the frequency of complications, such as acute urinary retention, postoperative bleeding and impaired passage of intestinal contents, reaches 15%.

For rectosigmoidectomy or Altmeier’s operation, it is necessary to dissect the mucous layer of the rectum along the entire circumference two centimeters above the dentate line, as in the Delorma operation.The next stage is the mobilization of the sigmoid and rectum and ligation of the vessels to the level of lack of excessive mobility. Further, the excess mucosa is cut off, after which it is necessary to impose a hardware or manual anastomosis. The positive side of this surgical intervention is the low percentage of bleeding from the anastomosis line, its inconsistencies, as well as a small number of purulent complications in the pelvic tissue. Recurrence of the disease is up to 30%, which, according to studies, decrease by 3-4 times, if this operation is supplemented with plastic surgery of the levator muscles.

Longo operation, also called transanal proctoplasty, involves the use of circular staplers. In this operation, semi-purse stitches are applied to the mucous membrane along its front and back surfaces. Then, one by one, on the head of the stapler, first tighten the front semi-purlin suture with excision of the excess mucosa, then tighten the stitches along the posterior semicircle on the head of the stapler and cut off the excess mucosa similar to the anterior semicircle.Longo’s operation can also be performed through the abdominal cavity, which expands the possibilities of this operation, allowing it to be used in a wider range of patients, including those with concomitant pathology. The incidence of postoperative complications reaches 47%.

Despite the minimal trauma of perineal interventions, a high percentage of relapses leads to their limited applicability. In recent years, an increasing percentage of surgical interventions are performed through the abdominal cavity, and most of the proposed techniques are either modifications of the described operations, or are only of historical interest and are not currently used.

The minimum percentage of relapses and better, in comparison with perineal operations, functional results determine the wider introduction of transabdominal interventions. It should be noted that due to the high percentage of postoperative complications in this type of surgery, its application to elderly patients with severe concomitant pathology is limited.

Of the most common interventions, it is worth noting:

• method of anterior rectal resection;
• rectopexy;
• rectopromontofixation;
• Wells surgery;
• Zerenin-Kummel surgery.

With anterior resection laparoscopic or open, an incision is made in the region of the mesentery root of the sigmoid colon up to the pelvic region, bordering the rectum. Further, mobilization of the sigmoid and rectum is necessary, while in the presence of a solitary ulcer, mobilization is performed below its level, that is, with the capture of the ulcerative defect in the mobilized area. Cut off the selected area and suture both ends of the intestine, often using linear devices for cutting off.Next, the head of the circular stapling apparatus is inserted into the adducting end of the intestine, and the stapling circular apparatus itself is introduced through the anal canal and, aligning the head with the apparatus, an end-to-end anastamosis is applied. After control of hemostasis and the consistency of the anastomosis, the operation is completed. According to research data, the percentage of relapses during such an operation increases with time and reaches 12-15%. Complications are detected in about a third of patients. It is worth considering the increase in the number of patients who develop one or another degree of anal incontinence (incontinence) associated with a lower rectal discharge necessary to remove a low solitary ulcer.

With rectopexy , the rectum is fixed above the promontory of the sacrum. Often, the first stage is resection of the rectum, with the anastomosis located above the promontory of the sacrum. This method has a relatively low recurrence rate, reaching 5%, while postoperative complications occur in about 20%. Also, some studies indicate an improvement in intestinal transit.

A number of authors are convinced of the need for subtotal bowel resection, however, recent studies indicate the rejection of the expanded volume in patients with anal incontinence, since the patients experience a deterioration in the function of the anal sphincter.

Rectopromontofixation begins with mobilization of the rectum to the right of it along the posterior and lateral semicircle up to the lateral ligament. In women, in the presence of prolapse of the rectovaginal septum, the latter is dissected and mobilized to the anal sphincter. In men, mobilization is carried out to the border of the middle and lower third of the ampullar rectum along the posterior semicircle. Next, a mesh prosthesis is fixed to the highlighted intestinal wall. With rectocele, the posterior vaginal fornix is ​​additionally fixed.The other end of the prosthesis is fixed to the promontorium.

Rectopromontory fixation scheme

A review of studies with a large number of patients revealed the occurrence of relapses in 3.5% of cases, while postoperative complications occurred in 25%. Disorders of the passage of intestinal contents occurred on average in 15% of cases.

Operative method according to Wells consists in cutting the peritoneum over the promontory of the sacrum up to the pelvic peritoneum and rectum on both sides.Next, the intestine is isolated up to the levator muscles along the posterior and lateral semicircles, to which the mesh prosthesis is fixed. The other end of the prosthesis is fixed to the promontory of the sacrum across the axis of the latter. The recurrence rate after this type of intervention reaches 6%, constipation occurs in 20%, and signs of anal incontinence occur in about 40% of cases.

The Zerenin-Kümmel operative method consists in opening the peritoneum to the Douglas space in front of the rectum, the latter being isolated to the levators.Further from the cape and below, sutures are applied, including the longitudinal ligament, and the line of sutures is continued to the anterior wall of the rectum. When the seams are tightened, a rotation of 180 degrees occurs, and the deep pocket of Douglas is eliminated. Relapse, according to the literature, occurs in about 10% of patients.

In surgical treatment of rectal prolapse, relapses are observed on average in about 30% of patients, with most of these patients having undergone perineal interventions.