Stages of rectal prolapse: Rectal prolapse – Better Health Channel
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 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
- 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: 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
Rectal prolapse | Health Information
Treatment for rectal prolapse
The best treatment for you will depend on the type of prolapse you have, as well as other things like your age and your overall health. In young children, especially those under the age of four, rectal prolapse usually gets better by itself, without any specific treatment. But for a full-thickness rectal prolapse, adults usually need an operation to fix it.
There are certain things you can do before or instead of surgery, to help manage your symptoms and stop your prolapse getting any worse. These measures are often enough for a partial prolapse.
Your doctor may gently push the prolapse back in, which is called ‘reducing’ the prolapse. They may show you how to do this yourself too. For more information, see FAQ: Should I push a rectal prolapse back in myself?
If you have constipation or diarrhoea, your doctor will give you advice on managing this, as it could be a factor in causing the prolapse. For constipation, this includes eating more high-fibre foods, such as fruit and vegetables and wholegrain carbohydrates, and make sure you’re drinking enough. Try not to strain when you have a bowel movement. Your doctor may also prescribe a laxative if necessary, to soften your poo.
Your doctor may also recommend that you use barrier creams around your anus, such as ones containing zinc or castor oil, as the mucus from the prolapse can irritate your skin. Your doctor will advise you what creams to use. They may also suggest specific exercises you can do to strengthen your pelvic floor muscles and prevent any worsening of the prolapse. If you choose not to have surgery or it’s not recommended for you, your doctor may suggest some support garments you can wear to stop the prolapse from coming out all the time.
Rectal prolapse surgery
It’s your choice whether to have any type of surgery that’s been recommended to you. But it’s important to realise that in adults, it’s unlikely that a full-thickness rectal prolapse will go away on its own. Surgery might sometimes be recommended for a partial relapse too. Children who have a complicated rectal prolapse, or whose prolapse hasn’t gone away within a year, may also need surgery.
If left untreated, a rectal prolapse is likely to get larger and come out more easily, and symptoms such as incontinence (losing control of your bowels) will continue to get worse. And the longer you leave it before seeking treatment, the more likely it is that you’ll get another rectal prolapse in the future. There can be other long-term problems too – see complications section below.
There are many different procedures which surgeons can use to treat a rectal prolapse. Your surgeon will discuss which one they recommend for you. Surgery for full-thickness rectal prolapse is carried out in one of the following two ways.
- Through your abdomen (tummy). This involves cutting into your abdomen to reach your rectum, and fix it in place (rectopexy) so that it doesn’t prolapse again. It may be an option to have this done with keyhole (laparoscopic) surgery, where your surgeon performs the procedure using instruments passed through tiny cuts in your abdomen.
- Through your perineum (the area around your anus). This is called perineal surgery – it can involve removing part of the prolapsed rectum and sewing in place the remaining section to prevent it happening again. Examples include the Delorme procedure and the Altemeir procedure. Your surgeon may be more likely to recommend perineal surgery if you’re not fit enough for abdominal surgery, as you don’t need to have a general anaesthetic. You can have this type of surgery with anaesthetic into your spine, which numbs the area.
If you have a partial (mucosal) prolapse, your surgeon will use different techniques to treat it. This may include cutting away the lining that has pushed through your anus or pulling the lining back into place, using a stapling instrument.
It’s possible to have another rectal prolapse after you’ve had surgery. This happens to around one in five people who have surgery for a rectal prolapse. How long it will take you to recover from surgery depends on many things, including the type of operation you had and your general health. For more information, read our FAQ, How long does it take to recover after surgery?
Gastroenterology | Rectal Prolapse Causes & Symptoms
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.
Rectal prolapse is usually caused by a weakening of the muscles that support the rectum. 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.
Rectal Prolapse Symptoms
- 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 into the anus by hand
- feeling pressure in your rectum
- being constipated
- having anal pain, bleeding, or itching
Who’s at Risk
Anyone can develop rectal prolapse, but women are more likely to have the condition than men.
Rectal prolapse can have many causes. These are some of the conditions that may increase your risk:
- a long history of constipation
- straining to have bowel movements
- laxative abuse
- spinal cord problems
- cystic fibrosis
Diagnosis of Rectal Prolapse
Your doctor 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 health providers may also do other tests to confirm the diagnosis. Tests may include:
- Anorectal manometry: A pressure-measuring tube placed inside the rectum to measure how well the muscles that control bowel movements are working.
- Endoscope: a flexible telescope placed inside the rectum so the doctor can do a visual exam
- Barium enema: x-ray pictures are taken after a type of contrast solutions is placed in the rectum
Rectal Prolapse 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 health care 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 operations, your surgeon must remove the part of the rectum that has prolapsed and join the two ends
- repair done by combining these techniques
These are the two main types of complications:
- A rectal prolapse that can’t be forced 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 requires emergency treatment.
- A rectal prolapse that happens again-this can happen up to 40 percent of the time. Following your doctor’s advice on lifestyle on lifestyle changes can help prevent recurrence. This includes eating a high-fiber diet and drinking enough water.
When to call the doctor
Call your doctor if you have any of these symptoms:
- fecal incontinence
Managing Rectal Prolapse
If you are recovering from rectal prolapse surgery, make sure to take your pain medicine as directed by your health care 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, such as straining to have a bowel movement or heavy lifting, for at least six months.
- have any persistent cough treated by your doctor
- no smoking
- eat at least 5 servings of fruits and vegetables every day. A high-fiber diet will help prevent constipation and straining
- drink six to eight glasses of water every day
- if you are constipated, as your doctor 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 diet
Rectal Prolapse Signs, Diagnosis, and Treatment
Probably the most common sign heralding colon cancer is rectal bleeding, but this symptom can also be caused by other conditions such as hemorrhoids and rectal prolapse. Rectal prolapse occurs when the last portion of your colon, the rectum, protrudes beyond the anus and is visible on the outside of your body.
If you have rectal prolapse, you may even be able to feel a small lump or soft piece of tissue extending from your anus. While it’s not a comfortable or natural feeling, most people with rectal prolapse state that it does not cause pain. Note, however, that most abnormal lumps around the anus are hemorrhoids.
Who Gets Rectal Prolapse?
Rectal prolapse is more common in adults and women after childbirth. It is relatively uncommon to see a small child with a prolapse unless it is caused by a congenital malformation of the pelvic floor—the smooth tissues and muscles that support your rectum.
As you age, these muscles lose tone and this can result in a small prolapse. Similarly, after women give birth to children, the muscles can relax and stretch, also setting the stage for a prolapse. Constipation and the consequential straining to move your bowels is also a common cause of rectal prolapse.
Signs of Rectal Prolapse
Aside from noticing rectal tissue outside of your anus, a prolapsed rectum may cause several other symptoms.
Verywell / Nusha Ashjaee
If you pass bloody stools, see blood in the toilet bowl after a bowel movement, or see blood on the tissue while wiping, call your doctor.
Rectal bleeding is a sign of colon cancer, but it also has several more innocuous causes including ulcers, gastrointestinal viruses, hemorrhoids or even a prolapse. You should never assume the cause of the bleeding — see your doctor and discuss it.
You might first notice a prolapse following a coughing or sneezing fit. If you have a rectal prolapse, the tissues can protrude with the increased pressure from coughing or sneezing and then retract when you are finished.
Diagnosing Rectal Prolapse
The easiest way to diagnose a rectal prolapse is through a complete physical examination. Your physician will take a history of your complaints and might be able to visualize the rectal tissue extending through your anus. Unlike hemorrhoids, a rectal prolapse can usually be gently tucked back up inside your rectum. If your doctor has concerns about the severity or underlying cause of your prolapse he or she may send you for further testing.
An evacuation proctogram is a highly specialized radiographic test used to detect and diagnose malformations of your pelvic floor—the area where your rectum lies. This test is not available in all locations due to the specialized equipment needed and is not frequently done for a routine problem.
Treating a Prolapsed Rectum
Most often a small rectal prolapse does not require any intervention or treatment, just monitoring. Making some simple dietary changes can help stop the progression of prolapse. Increasing your fluid and fiber intake will help to decrease the amount of time you spend straining on the toilet to pass a bowel movement.
In some cases, surgical correction of the prolapse is required. The majority of healthy adults will require general anesthesia for this (you are put to sleep for the surgery by an anesthesiologist).
There are several different ways that your surgeon can surgically correct the prolapse, but most techniques involve removing a small portion of your colon and reattaching it to your anus. This is a major surgery that requires hospitalization; discuss the risks and benefits with your doctor.
When to Call Your Doctor Immediately
It is an emergency if you have a known rectal prolapse that stays on the outside of your body. The prolapsed tissue can become strangulated and start to lose circulation, and as the tissues lose circulation, they become necrotic and die. This requires serious medical treatment and most likely surgery to correct.
Go to the emergency room if rectal prolapse is accompanied by pain, fever, or a lot of bleeding; if you suspect a rectal prolapse is staying outside your body; or have a large prolapse. If the prolapse isn’t causing symptoms, make an appointment with your physician.
You should always report any rectal bleeding. The cause might be innocuous, but you won’t know until you speak to your doctor. If significant enough, continuous blood loss can cause serious problems.
Pelvic Organ Prolapse: What is Pelvic Organ Prolapse? Pelvic Organ Prolapse Symptoms, Treatment, Diagnosis
What is Pelvic Organ Prolapse?
Pelvic organ prolapse (POP) occurs when the tissue and muscles of the pelvic floor no longer support the pelvic organs resulting in the drop (prolapse) of the pelvic organs from their normal position. The pelvic organs include the vagina, cervix, uterus, bladder, urethra, and rectum. The bladder is the most commonly involved organ in pelvic organ prolapse.
Symptoms of Prolapse
Many women with Pelvic Organ Prolapse have no symptoms at all, however some women may experience one or more of the following:
- Discomfort (usually pressure or fullness)
- Bleeding from the exposed skin that rubs on pads or underwear
- Urinary symptoms of leakage, difficulty starting the stream of urine, or frequent urinary tract infections
- Difficult bowel movements—the need to strain or push on the vagina to have a bowel movement
- A bulge near the opening of the vagina or a sensation of pressure in their pelvic region and/or lower abdomen
Symptoms often progress very gradually. And you may make changes in physical or social activities that go unnoticed by others until they become extreme. More rarely symptoms of prolapse can present suddenly.
As POP worsens, you may notice:
- A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements
- The feeling of “sitting on a ball”
- Needing to push stool out of the rectum by placing fingers into or around the vagina during a bowel movement
- Difficulty starting to urinate or a weak or spraying stream of urine
- Urinary frequency or the sensation that you are unable to empty the bladder well
- Lower back discomfort
- The need to lift up the bulging vagina or uterus to start urination
- Urinary leakage with intercourse. Though unusual, severe prolapse can block the flow of urine and cause recurrent urinary tract infections or even kidney damage.
Types of Prolapse
Anterior Vaginal Wall Prolapse (Cystocele or Urethrocele)
Anterior vaginal wall prolapse often occurs at the top of the vagina where the uterus used to be in women who have had a hysterectomy. This type of prolapse occurs when the bladder’s supportive tissue, called fascia, stretch or detach from the attachments securing it to the pelvic bones. With this loss of support, the bladder falls down into the vagina. As this condition worsens, the prolapsed pelvic organs may bulge outside the opening of the vagina causing pressure, discomfort or pain. Other symptoms MAY include:
- Urinary frequency, nighttime voiding, loss of bladder control and recurrent bladder infections—usually due to the bladder not emptying well
- Stress urinary incontinence (SUI) with activity such as laughing, coughing, sneezing, or exercise) cause by weakened support for the urethra
Posterior Wall Prolapse (Rectocele or Enterocele)
This type of prolapse occurs when the support tissue or fascia between the vagina and rectum stretches or detaches from its attachment to the pelvic bones. With this loss of support, the rectum or intestines fall (prolapse) into the vagina causing it to bulge or protrude outward. Symptoms typically include:
- A bulge sensation
- Problems having a bowel movement such as straining more with bowel movements and the feeling of not completely emptying the bowels
- The need to put your finger in or around the vagina or rectum to help empty bowels
Uterine prolapse is a condition that occurs when the muscles and tissue in your pelvis weaken. Your uterus drops down into your vagina. Sometimes, it comes out through your vaginal opening. Nearly half of all women between ages 50 and 79 have uterine prolapse, or some other form of pelvic organ prolapse
Many women with uterine prolapse have no symptoms. However, if symptoms start, they may include:
- Leakage of urine
- Feeling of heaviness or fullness in your pelvis
- Bulging in your vagina
- Lower-back pain
- Aching, or the feeling of pressure, in your lower abdomen or pelvis
Apical Prolapse (Vaginal Vault Prolapse) or Uterine Prolapse
If a woman has had a hysterectomy, the top part of the vagina (vault) can become detached from the ligaments and muscles of the pelvic floor. Often, uterine or vault prolapse is associated with loss of anterior or posterior vaginal wall support. When the cervix protrudes outside the vagina, it can develop ulcers from rubbing on underwear. Sometimes these ulcers will bleed if they become irritated. Most women experience symptoms of bulge or pressure sensation in the pelvis.
Like the vagina and uterus, ligaments and muscles securely attach the rectum to the pelvis. Infrequently, the supporting structures stretch or detach from the rectal wall and the rectum falls out through the anus. Early on, women may notice a soft, red tissue protruding from the anus after a bowel movement. It can be confused with a large hemorrhoid. Other symptoms may include:
- Pain during bowel movements
- Mucus or blood discharge from the protruding tissue
- Loss of bowel control
Risk factors for rectal prolapse include conditions associated with straining such as chronic constipation or diarrhea, nerve and muscle weakness (paralysis or multiple sclerosis), and advancing age are risk.
Who’s at risk?
If you have given birth, you have the highest risk for uterine prolapse. If you’ve had a vaginal delivery, you are more likely to develop uterine prolapse than if you’ve had a C-section. If you are menopausal, Caucasian, overweight, or obese, you are also more likely to experience uterine prolapse. Smoking is another factor that increases your risk.
If your doctor suspects that you have a prolapse in one or more pelvic organs, he or she will probably perform a physical examination to check for irregularities in your pelvis. If you’re also having problems like urinary incontinence or a feeling of incomplete emptying of your bladder, your doctor may perform a procedure called a cystoscopy to examine your bladder and urethra.
Your physician might also order imaging of the pelvic organs such as an ultrasound (sonogram) or an MRI (magnetic resonance imaging). This will allow your doctor to assess your kidneys and other pelvic organs when indicated.
If your prolapse symptoms bother you or keep you from feeling comfortable during everyday activities, talk with your doctor about treatment options. Lifestyle changes like losing weight coupled with routine Kegel exercises can also be helpful. These strengthen your pelvic floor muscles. To perform a Kegel exercise, you squeeze the muscles you use to control the flow of urine, and hold for up to 10 seconds before releasing. Aim for 50 repetitions a day.
A pessary can provide relief from the symptoms of uterine prolapse. This is a device your doctor inserts into your vagina to support your pelvic organs.
When symptoms are more bothersome surgery can be considered. There are many types of surgeries that can be performed depending on which organs are prolapsed. Options depending on your condition and other factors include minimally invasive approaches like vaginal, robotic or laparoscopic surgery and sometimes open abdominal surgery. The goal of surgery is to restore pelvic organ support. In some cases of uterine prolapse hysterectomy or uterine suspension procedure may be recommended. These procedures can be done in a minimally invasive fashion. For example, with a vaginal hysterectomy your doctor removes your uterus through your vagina. The healing time is faster. There also are fewer complications than with traditional hysterectomy, which requires an abdominal incision. In some cases of uterine prolapse uterine sparing surgery may be appropriate.
Surgery for pelvic organ prolapse carries the risks that all surgery has. This includes the chance of bleeding, infection, injury to the body area involved (in this case, the urinary tract), and problems related to anesthesia.
There is no surefire way to prevent pelvic organ prolapse. However, you can lower your risk by:
- Losing weight if you’re overweight
- Following a diet rich in fiber and fluids to prevent constipation and straining
- Avoiding heavy lifting
- Quitting smoking
- Seeking prompt treatment for a chronic cough, which can place extra pressure on your pelvic organs
- Regularly performing Kegel exercises to strengthen your pelvic floor muscles
These strategies may also help if you have already developed uterine prolapse.
Consult your doctor when pelvic organ prolapse symptoms first start to bother you. Don’t wait until your discomfort becomes severe. Regular pelvic exams can help detect uterine prolapse in its early stages.
Surgery is an option, but not always necessary. Medical devices, exercises, and lifestyle changes can sometimes provide relief from bothersome symptoms.
Download: Robotic Surgery for Pelvic Organ Prolapse
Download: Treating Prolapse with Surgery
Download: Uterine Prolapse without Hysterectomy
Rectal Prolapse: Symptoms, Causes, Treatment, Surgery
Rectal prolapse is not incredibly common, affecting roughly 2.5 out of every 100,000 people. Still, it’s essential to know the signs and symptoms of rectal prolapse, as a majority of those cases are women who are over the age of 50. The medical term “prolapse” comes from the Latin prolabi, meaning literally “to fall out,” and refers to when an organ falls or slips out of place and is no longer located where it should be. When a rectal prolapse occurs, the rectum begins to push its way through the anus slowly, and in more severe cases, the rectum can push its way through and be visible externally. Usually, the rectum is the last part of the large intestine and remains firmly attached, unless there is a case of prolapse. Read on to learn more about the causes and risk factors for rectal prolapse, the differences between prolapse and hemorrhoids, what to do if you suspect prolapse, and what treatments are available.
Causes, Risk Factors, and Related Conditions of Rectal Prolapse
Doctors are not always able to pinpoint why some patients get rectal prolapse and others do not. However, there are some specific causes in some patients. Pregnancy can be a cause in some patients. Because pregnancy lowers the pelvic floor, in some patients this can cause rectal prolapse. In addition, some patients may strain while pushing during labor and delivery.
In that same vein, if you find yourself routinely constipated and pushing and straining while trying to force a bowel movement, this may predispose you to a rectal prolapse either now or later in life, particularly if you’re female. Women over 50 are six times more likely to develop rectal prolapse than any other age group or gender group, with women over 60 being the age group most likely to have rectal prolapse. This is because of the overall weakness of the pelvic floor. Also, conditions that make you cough a lot – such as chronic bronchitis – can be a precursor to rectal prolapse.
Doctors have also noted that 15 percent of patients with rectal prolapse also suffer from chronic and frequent diarrhea, although the connection between the two is not known.
Certain conditions are also correlated with rectal prolapses, such as multiple sclerosis (MS), spinal tumors, lumbar disk disease, or any type of injury to the pelvis or lower back.
Factors that may put you at risk for rectal prolapse, other than age, include:
- Chronic obstructive pulmonary disease (COPD)
- Cystic fibrosis
- Parasitic infections
- Weakened anal sphincter
It is unlikely for children to suffer from rectal prolapse, but it is possible, particularly if they also suffer from a correlating disease or conditions, such as MS.
Rectal Prolapse Vs. Hemorrhoids
Rectal prolapse may be slightly uncommon, but hemorrhoids are not. Very often, prolapse can be mistaken for what is a severe case of hemorrhoids. However, how can you tell? It can be tough to know on your own, considering your angle of viewing. If you’re unsure, it’s best to go to your doctor for an evaluation. A rectal prolapse involves the protrusion of the rectum, often out through the anus, while hemorrhoids are swollen blood vessels that appear on the walls of the anus and the lining of the rectum. Both of these conditions can be very painful, however, hemorrhoids can often be treated with over-the-counter medications. If hemorrhoids become more severe, they can be mistaken for prolapse because they can become painful and itchy, and you may also see a spot of red on the toilet paper after wiping, which is also something you’d see with prolapse. More severe hemorrhoids will require medical intervention, to begin with, so the best thing to do in this case is to make an appointment with your healthcare provider so you can receive the proper treatment, whether it is prolapse or hemorrhoids.
Symptoms and Complications
You likely won’t notice the symptoms of rectal prolapse overnight, and symptoms will begin to manifest gradually. One of the first things you may feel is a bulge near the opening of your anus. When you sit, you may feel the sensation of “sitting on a ball,” no matter where you’re sitting or what kind of material you’re sitting on. If you feel that something is awry, take a handheld mirror with you next time you prepare to make a bowel movement. If you’re experiencing rectal prolapse, you may see a reddish-brown bulge extend from the anus. You may even see it emerge from the anal cavity, and return into the cavity after your bowel movement. This is a pretty indicative sign of a prolapse.
If prolapse worsens and help isn’t sought, the rectum may emerge when you are performing physical activity or even normal daily activity, such as walking or going down or up a set of stairs. In the beginning, you may be able to return the rectum to its position, but over time, returning it to its position will become more challenging, and your health will be at greater risk. As the prolapse worsens, you may experience constipation or fecal incontinence, depending on the type of prolapse it is.
Types of Prolapse
There are three distinct types of rectal prolapse that range in severity:
- Internal: The rectum has dropped and is considered a prolapse because it has moved, but it has not pushed through the anus
- Partial: Only a portion of the rectum has moved into the anus
- Complete: The entire rectum extends out through the anus (most serious)
When to See a Doctor
Rectal prolapse isn’t a life-threatening emergency, especially in the beginning stages. However, it becomes a major quality of life issue in the middle and later stages and types if it is not addressed. Rectal prolapse will not get better on its own and will only increase in severity. If you think you may have rectal prolapse, then it is a good idea to see your physician as soon as possible before permanent damage is done (such as nerve damage), which can result in unwanted outcomes such as permanent fecal incontinence.
Rectal prolapse may take years to progress from mild to severe, and your doctor may even choose to delay treatment based on your degree of severity. Still, it’s always best to get a medical opinion.
Rectal Prolapse Treatment
The only way to effectively treat a rectal prolapse is through surgery. This is in part why your doctor may choose to delay treatment if your prolapse symptoms are mild in the beginning. There are two ways to perform the surgery to put the rectum back into place. The surgeon can perform it through the abdomen (either open surgery or laparoscopically), and the rectum is pulled back into place, or the surgeon can perform it through the anus. This is a second option for those who cannot have abdominal surgery. This surgery can only be performed using open surgery. The surgeon will remove part of the rectum, replaced, and reattached to the large intestine to fix the prolapse.
How to Prevent Rectal Prolapse
There are a few ways to prevent rectal prolapse, particularly if you meet one of the other risk factors. You can:
- Take stool softeners regularly, so you don’t push and strain during bowel movements. Stool softener should not be confused with laxatives. Even over the counter laxatives should be used infrequently or under a doctor’s supervision
- Eat plenty of high-fiber foods for regularity
- Drink plenty of water for hydration
- Exercise and lead a non-sedentary lifestyle
- Perform Kegel exercises to keep your pelvic floor muscles strong
- Manage stress with meditation and self-care techniques
To learn more about rectal prolapse, or if you would like to be evaluated by a physician, request an appointment as Gastroenterology Consultants of Savannah, P.C. today. We have five Georgia locations and one South Carolina location to help provide individualized care and serve you better.
90,000 Rectal prolapse – treatment methods, stages of node prolapse, symptoms and complications
There are contraindications. Consultation of a specialist is required.
Rectal prolapse , or rectal prolapse is a pathological condition that is accompanied by the release of the mucous membrane beyond the boundaries of the anal sphincter. All layers of the diastal segment of the large intestine fall out. The protruding segment in this case is from 2 to 20 centimeters and even more.
This disease is often diagnosed in men, accounting for 70% of clinical cases. In 30%, pathology occurs in women. Prolapse is predominantly formed in people of working age from 20 to 50 years old, but it is often found in babies 3-4 years old due to the specific anatomical and physiological characteristics of the child’s body.
Reasons for weakening of muscles and ligaments, which leads to prolapse of rectal nodes:
- hereditary predisposition;
- Incorrect anatomical structure of the pelvic bones, shape and rectum and sigmoid colon, intestinal wall;
- prolonged defecation disorders: diarrhea, constipation;
- Excessive straining during urination;
- parasitic intestinal infections;
- Regular physical activity that is too strong, hard work, lifting weights;
- diseases of the nervous system.
90,015 injuries to the pelvic nerves and muscles;
90,015 heavy or multiple childbirth in women;
The official classification of rectal prolapse in humans is used by specialists when they develop a treatment regimen. It provides for the distribution of pathology into three stages:
- Stage 1 (compensated) – the intestine falls out only during defecation and returns to its natural position on its own;
- Stage 2 (subcompensated) – prolapse appears during bowel emptying and during high physical exertion, accompanied by insufficiency of the anal sphincter;
- Stage 3 (decompensated) – prolapse of the rectum is observed even when walking, coughing, sneezing, accompanied by incontinence of feces, gases, severe sphincter insufficiency.
Experts also distinguish two variants of rectal prolapse:
- Hernial – Douglas pocket and the anterior rectal wall are displaced downward, while weak pelvic floor muscles and constant high intra-abdominal pressure lead to prolapse of the intestine into the anal canal. After a while, all walls are involved in the pathological process, and the sagging increases.
- Invagination , or internal prolapse – a part of the rectum or sigmoid colon is introduced into the lumen of another part of the intestine.In this case, the organ does not come out, and the main sign of pathology is regular severe pain attacks.
Symptoms of pathology occur both gradually and suddenly. An unexpected start is associated with sharp and intense exertion, straining. After such an episode, the rectum falls out, and the person feels sharp pains in the abdomen, up to painful shock.
However, more often rectal prolapse develops gradually. Along with the progression of the pathology, the signs of loss become more pronounced:
- foreign body sensation in the anus;
- abdominal pain, which worsens during walking, exertion, defecation;
- incontinence, inability to keep gas, feces;
- Frequent false urge to defecate;
- feeling of incomplete bowel movement;
- frequent urination;
- discharge of mucus, blood from the anus;
- the formation of a solitary ulcer, edema of the mucous membrane (with internal prolapse).
Complications if untreated
The most dangerous complication that appears when you ignore prolapse is infringement of the prolapsed segment of the intestine. Infringement appears when untimely intervention or when trying to correct the prolapse on your own. It is accompanied by edema, increasing ischemia, impaired blood supply. If you do not seek help in time, necrosis (tissue necrosis) will strike the outer tissue.
Another complication caused by pathology is solitary ulcers.Over time, such wounds cause bleeding, causing perforations.
With advanced stages of internal prolapse, acute intestinal obstruction and peritonitis often occur. These are dangerous conditions that pose a threat to human life.
To diagnose rectal prolapse and the degree of bowel prolapse, the proctologist may not even be based on examination and analysis of symptoms. The fallen part of the organ has a conical, cylindrical or spherical shape, painted in a bright red or bluish tint.The mucous membrane is characterized by pronounced swelling, bleeds on contact. In the early stages, it is possible to correct the intestine and restore the normal state of the tissues. If at the time of examination, prolapse is not observed, the patient is asked to strain to provoke prolapse.
During a digital examination, the doctor determines the tone of the sphincter, differentiates the disease from hemorrhoids and anal polyps. After that, for an accurate diagnosis, identification of complications and the exact stage of the disease, instrumental diagnostics are performed, which includes:
- colonoscopy – to identify the causes of the pathology;
- irrigoscopy – to detect functional changes in the colon;
- defectography (proctography) – to determine the degree of prolapse;
- anorectal manometry – to assess muscle function;
- endoscopic examination (sigmoidoscopy) – to detect intussusception, the presence of ulcers;
- endoscopic biopsy with tissue examination – prescribed when a solitary ulcer is found to exclude rectal oncology;
- gynecological examination – for women.
Methods for the treatment of rectal prolapse
Conservative approaches are used only in the very early stages of the disease. The main goal of such activities is to normalize the stool and exclude increased intra-abdominal pressure. Clinical practice guidelines include:
- fiber-rich diet;
- drinking plenty of fluids;
- drugs to enhance peristalsis;
- neurostimulation, which helps to regain muscle control in case of disturbed innervation.
Surgical methods of treatment bring results at later stages of prolapse development, as well as in cases where conservative therapy does not give a positive effect. There are many operations that help get rid of the pathology. They provide:
- excision of the prolapsed rectum;
- intestinal fixation;
- plastic surgery of the anal canal, pelvic floor;
- colon resection;
- combined methods.
Resection of the prolapsed section is more often done with the help of Delorm’s operation. The surgeon removes the mucous membrane and forms a new muscle layer in the anal canal. The operation is low invasive and is suitable even for older patients with serious chronic pathologies. Less often, the resection of the fallen out lobe is done by flap excision according to Nelaton or circular removal according to Mikulich.
Among the methods of fixation, rectopexy is considered the most effective – an operation in which the pelvic intestine is attached to the walls of the pelvis, thus restoring the correct anatomy of the organ.The operation is performed on patients under 50-55 years old. In 97% of cases, organ prolapse is eliminated.
Plastic surgery of the anal canal helps to narrow the anus using surgical sutures and wires, synthetic materials. However, this group of methods has a high risk of recurrence and is therefore rarely used.
Resection of the diastal parts of the large intestine is necessary if the patient has a solitary ulcer or necrosis. Often this operation is combined with fixation operations.
The SM-Clinic surgeons have experience in carrying out various types of operations to eliminate prolapse. The doctors of our clinic are fluent in modern surgical techniques and successfully help patients get rid of pathological intestinal prolapse.
Surgical treatment yields a positive result without relapse in 80% of cases. In 70-75% of patients, as a result of treatment, the evacuation ability of the intestine is restored. Moreover, in 25-30% of patients, transient dysfunction occurs.
Moreover, the earlier the patient seeks help, the more favorable the prognosis will be. Unfortunately, patients often go to the doctor only at the later stages of the development of pathology, when prolapse is already obvious, intestinal functions are impaired, and irreversible changes have begun in the tissues. In this case, the risk of developing life-threatening complications increases significantly.
To prevent the disease, as well as to prevent relapse, doctors recommend eliminating factors that increase intra-abdominal pressure and cause weakness of the pelvic floor muscles:
- avoid injuries in the pelvic, sacrum area;
- physical activity, stress;
- Treat constipation, flatulence, diarrhea;
- do not start urolithiasis, prostate adenoma;
- Do not allow a harsh painful cough.
Pathology develops as a result of a combination of several factors, therefore, for prevention, all risks must be minimized.
90,000 Rectal prolapse – Medical Center
Rectal prolapse is a common pathology characterized by intestinal prolapse from the anus.
Reason – weakness of the ligamentous apparatus , violation of collagen metabolism. And constipation is the producing factor. Elderly people are more often sick, and initially such patients suffer from hemorrhoids and as a result, complete intestinal prolapse may develop with the development of fecal incontinence.
The main complaints of rectal prolapse is the prolapse of the intestine, first only after stool, and subsequently and permanently. Weakness, staining of underwear, anal itching, and subsequently incontinence of gases and feces also joins. There are also frequent episodes of bleeding unrelated to stool. The disease develops for a long time, but with heavy physical exertion, with sneezing, coughing, it can develop rapidly.
There are 4 stages of the disease. If we say the first stages can be treated conservatively, then 3-4 stages only by surgery
Treatment methods in rectal prolapse
In the initial stages, it is possible to use massage, gymnastics to normalize the chair, and special poses during bowel movements.At the appointment with the proctologist of our center, you can get detailed information.
Operations are also divided into palliative, radical and minimally invasive.
Patients are only interested in those operations that can be performed minimally invasive, outpatient and with the least health risk. Our clinic has developed a unique minimally invasive method for treating rectal prolapse using the Longo method. The operation is performed under general anesthesia and by the evening the patient is allowed to go home. We are the only ones in the Irkutsk region and Irkutsk to perform such a series of manipulations with good long-term results.
In severe cases intra-abdominal operations are performed laparoscopically.
The medical center receives residents of the cities: Irkutsk, Shelekhov, Angarsk, Bratsk, Usolye-sibirskoye, Cheremkhovo and other cities of the Irkutsk region.
90,000 causes and symptoms, diagnosis, treatment and prevention
Causes of 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:
- indigestion disorders, accompanied by painful urge to defecate and sphincter spasms;
- 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 during bowel emptying, in most cases the site is pulled back on its own or can be painlessly adjusted 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
Rectal prolapse is a pathological condition in which the rectum, falling downward, protrudes, or rather, turns outward through the opening of the anus. This is a pathology associated with a violation of fixation of the rectum with the walls of the pelvis with weakening of the pelvic floor muscles.Complete prolapse of the rectum along the clinical course, in most cases, can be divided into four stages.
Clinical classification of total rectal prolapse:
- STAGE I – prolapse during bowel movements, self-reduction.
- STAGE II – prolapse during bowel movements, cannot be adjusted independently.
- STAGE III – loss with light stress.
- STAGE IV – complete bowel incontinence with constant prolapse after reduction.
Diagnosis of rectal prolapse treatment
Differential diagnosis is carried out mainly with hemorrhoids with prolapse of internal nodes. The main differences are that the length of the prolapsed column during prolapse can be up to 15 centimeters or more, while with hemorrhoids, the prolapsed area cannot be longer than 2-3 cm and, in addition, when the intestine is prolapsed, the entire structure of its inner wall is visible ( transverse folds), and with hemorrhoids, the “bouquet” of falling nodes is divided into lobes and the dentate line of the anal canal does not turn out.These clear differences, however, do not always contribute to the correct diagnosis, and we have repeatedly seen patients with the first degree of rectal prolapse, operated on for hemorrhoids, and vice versa. It is clear that such operations are inadequate. In differential diagnosis, it is necessary to remember about the prolapse of tumors from the rectum (large polyps on the leg).
In children (up to 2-3 years old), the introduction of a glycerin suppository is used for diagnosis, which causes the urge to defecate and the shape and length of the prolapsed intestine can be seen.In all cases, a digital examination of the rectum and rectoscopy are necessary to exclude prolapsed polyps. Differential diagnosis of hemorrhoids with prolapse of internal nodes and initial forms of rectal prolapse is difficult; it is based on the different lengths and shapes of the dropouts.
Most often, the treatment of rectal prolapse is operative. Only in children it is sometimes possible to achieve success with conservative measures. Although in the structure of all proctological diseases this ailment does not occupy a leading position in terms of frequency of occurrence, however, the lack of perfect treatment methods and frequent relapses force surgeons and coloproctologists to look for more reliable and effective ways to correct this pathological condition.
All existing methods surgical treatment rectal prolapse can be divided into five groups.
1. Methods of narrowing the anus or artificial reinforcement of the external sphincter
2. Operations of rectopexy or attachment of the distal rectum to the fixed parts of the small pelvis
3. Methods of colopexy, ie transperitoneal fixation of the distal sigmoid colon to the immobile formations of the pelvis or abdominal wall
4.Operations aimed at strengthening the pelvic floor and perineum
5. Methods of partial or complete resection of the prolapsed intestine.
Operations performed in the treatment of rectal prolapse
– Kummel’s operation : the rectum stretched upward is sutured with interrupted serous-muscular sutures to the longitudinal ligament of the sacral promontory. Recently, this operation is most often performed in our clinic laparoscopically.
price for surgery in the clinic, make an appointment, doctors, patient reviews
Contents ↓ [show]
Rectal prolapse is an unpleasant disease, but in most cases it can be successfully treated.There are several different techniques, they are used in the Yusupov hospital.
In our clinic you can get advice and be examined by a coloproctologist of the highest qualification category Efim Igorevich Kharabet. Our doctors carry out all types of diagnostics necessary to understand the nature of the pathology and choose an effective treatment.
Our specialists select the optimal method for eliminating rectal prolapse individually for each patient. Treatment takes place quickly, the patient gets rid of unpleasant symptoms in the shortest possible time and returns to his usual life.
Prices for the treatment of rectal prolapse
* Information on this site is for informational purposes only. All materials and prices posted on the site are not a public offer determined by the provisions of Art. 437 of the Civil Code of the Russian Federation. For accurate information, contact the clinic staff or visit our clinic.
Download price list for services
Rectal prolapse or rectal prolapse is a partial or complete prolapse of the rectum beyond the anal sphincter.The pathological condition of the intestine does not threaten the patient’s life, but worsens its quality, causes severe discomfort. Most often, rectal prolapse occurs in the elderly, equally often in men and women, the disease is rare. There are no optimal treatments, and there are many different types of surgery for rectal prolapse. The cause of the development of pathology has not yet been established.
The Coloproctology Department of the Yusupov Hospital is a modern clinic that provides a wide range of medical services.The department carries out operations to treat proctological diseases. Operating hospitals are equipped with modern equipment for performing operations by various methods – laparoscopic, laparotomy, endoscopic and other methods. Patients are treated on an outpatient basis and in a hospital. In the hospital, you can undergo diagnostics, take tests, get advice from multidisciplinary doctors, including the help of proctologists-oncologists.
Symptoms of the disease
Rectal prolapse can occur when coughing, lifting heavy objects, or other circumstances when intra-abdominal pressure rises.Rectal prolapse is accompanied by abdominal pain due to tension in the mesentery; increased pain can lead to the development of pain shock. Often, the first symptoms of the disease appear in childhood: persistent constipation from infancy, abdominal pain. Over time, the condition worsens – the rectum protrudes from the anus during straining, when coughing, lifting weights. At first, the intestine can adjust itself or the patient can adjust the part of the prolapsed intestine with his fingers, then the rectum stops adjusting.
The prolapsed rectum causes itching, mucous discharge remains on the clothes, blood appears, the patient feels a foreign body in the anal passage. The tissues of the prolapsed rectum are edematous, loose. Fecal incontinence, gas incontinence develops, false urge to defecate constantly occurs. The pain increases with physical exertion, bowel movement, walking, running, exercising, after the rectum is repositioned, the pain goes away. There are several stages of rectal prolapse:
- The first stage is characterized by a slight protrusion of the rectum from the anal passage.
- The second stage of rectal prolapse is characterized by a slight prolapse of the rectum during straining. The anal opening is normal.
- The third stage of rectal prolapse is characterized by prolapse of the rectum under any load – coughing, sneezing, straining, lifting weights and other loads. Rectal prolapse is accompanied by uncontrolled incontinence of feces and gases. The third stage is accompanied by the development of necrosis and erosion of rectal tissues, bleeding.At this stage of rectal prolapse, the sphincter relaxes, a gaping anus is formed.
- The last stage of rectal prolapse is a serious condition in which an organ prolapse occurs when the body is upright, there is a prolapse of parts of the sigmoid colon. In the mucous tissues of the rectum, areas of necrosis appear, in the area of the anus, itching, pain, the sensitivity of the anus is disturbed.
There are a number of factors that contribute to the development of pathology:
- Weakness of the ligamentous apparatus.
- Overactive rectum and sigmoid colon.
- Expansion of the rectal ampulla.
- Elongated rectal mesentery.
- Deep rectal uterine cavity.
- Rectal prolapse often occurs with abdominal trauma.
- Diastasis of the muscle supporting the anal passage.
- Gaping passage (weak sphincter).
- Vertical position of the coccyx and sacrum.
- Heavy and prolonged labor.
- Increase in intra-abdominal pressure under the influence of various factors.
- Heavy physical activity.
- Surgical intervention on the pelvic organs.
- Severe exhaustion.
- Neurological disorders.
- Frequent constipation.
Treatment in Moscow
Treatment of pathology in the coloproctology department of the hospital is carried out by a surgical method, with rectal prolapse, conservative therapy does not bring success.After surgical treatment of rectal prolapse, in some cases, doctors cannot restore the function of retaining feces and gases. Most often, pathology is treated with presacral rectopexy. This method helps to strengthen the ligaments that support the rectum, and if necessary, strengthen the muscles and ligaments of the anal passage. Operations are performed using the laparotomy method.
Treatment of rectal prolapse in women is carried out in conjunction with a gynecologist. Rectal prolapse in women is accompanied by urinary incontinence, prolapse and prolapse of the uterus, perineum, and rectal ulcer syndrome is often noted.Treatment of rectal prolapse is carried out along with conservative therapy of ulcerative lesions of the rectum. If conservative treatment has not been successful, various minimally invasive and surgical methods are used: rectal excision, cryodestruction, photocoagulation, and others. In the hospital, patients with rectal prolapse will be able to receive assistance from multidisciplinary doctors. You can make an appointment with a doctor by calling the hospital.
- ICD-10 (International Classification of Diseases)
- Yusupov Hospital
- Kaiser A.M. Colorectal surgery. Moscow: Panfilov Publishing House, 2011 .– 755 p.
- Vorobiev G.I., Tsar’kov P.V. Basics of intestinal stoma surgery. Moscow: Stolny grad, 2002.
- Vorobiev G.I., Khalif I.L. Non-specific inflammatory bowel disease. Miklos, 2008.
Treatment of rectal prolapse in Privatklinik
How to build trust with a patient – an interview with an obstetrician-gynecologist. gynecologist-endocrinologist Magda Avtandilovna Gevorkyan.
Magda Avtandilovna Gevorkyan – obstetrician-gynecologist with 14 years of experience.Looking at this incredibly beautiful woman with a thin waist and a radiant smile, you would not think that a doctor already has such a colossal experience. But Magda Avtandilovna manages not only to help patients every day, but also to manage the antenatal clinic, carrying out managerial and organizational activities. And she has something to share with her colleagues. Due to her natural modesty, Magda Avtandilovna does not consider her way of working and interacting with her patients to be something unique. But thanks to this naturalness, open smile and lack of pride or arrogance, this doctor already has his own “army” of loyal patients.
“Where do I work …”
I work at the Lobnenskaya Central City Hospital as the head of the antenatal clinic. I also conduct an appointment as an obstetrician-gynecologist at PrivatKlinik and at the antenatal clinic.
“What are you proud of in your work, what achievements?”
You know, it’s hard to say so, maybe you shouldn’t be so direct … praise me? (laughs) I’m at PrivatKlinik from scratch. From the very beginning, we developed programs for women, showing maximum concern for them.Then they constantly corrected and added, based already on the requests of patients and on the basis of Clinical Recommendations and Orders of the Ministry of Health of the Russian Federation. I remember when the clinic had just opened, the patients did not really know about us, and I supported the head doctor: “Don’t worry, I always have a lot of people. I have such an aura. ” And so it began. Patients began to arrive. I was somehow embarrassed to tell the patients that I conduct an appointment not only at the residential complex, but also at PrivatKlinik. It seemed to me that the patients already knew. And when I had been working for 2 years already, and the girls were still wondering what I accepted at PrivatKlinik, I understood one very seditious thought.
It is very difficult to predict what a person is actually thinking. You say one thing, and the patient, due to his excitement at the reception, emotional experiences and fears, perceives something completely different. And he understands what he himself wants to hear at this moment.
And the percentage of perceived information strongly depends on whether the doctor has managed to accommodate the patient, to inspire his confidence. No matter how superprofessional the doctor is, if the patient has no trust, he will not accept this information, will not follow the prescriptions and recommendations.And of course there will be no result.
Therefore, I stopped thinking that the patient hears everything and understands everything and that “everything is clear anyway”. I began to say everything at the reception, explaining every detail in the appointment, why we pass this or that analysis, what will be the outcome if we do it or not. But this is possible only within the framework of full-fledged receptions, and not only those short meetings that we have in the framework of the antenatal clinic. Of course, there I cannot conduct an appointment in such detail, I only have time to outline the very essence, there are not enough doctors, and there are a lot of patients.
My family is proud to be a doctor. But to become a doctor, you have to go through such a difficult and long path that this feeling of self-pride does not remain inside. There is probably no time for this pride. I am a person who works 12 hours a day every day. But what I’m really proud of is my beautiful daughter. She is 8 years old.
The global transformation of me, as a gynecologist, took place after I myself went through the path of my pregnancy and childbirth.
Although I do not attend the birth directly, I believe that I give birth with each of my patients.Especially difficult pregnancies. Always the feeling that we are together: “Hurray! We gave birth to a healthy baby! ”
“What came with experience?”
I am not afraid of patients, I don’t think how can I say so in order to please. As it was in the internship or immediately after. With experience, I became confident that in front of me was a person whom I had to help. And I would like to help you SO that the patient would come only from preventive
in the future.
target. What I like about obstetrics and gynecology is that you will meet with your patient anyway, because
is what matters here
preventive appointment.You don’t have to wait that
only if he gets sick, he will come. We have such a specialization that a person comes to us to plan a pregnancy, to carry a baby. This is very supportive in the work.
I am an adherent of the idea that the main thing is trust. Therefore, if the patient does not have confidence in the doctor, it is better to change the doctor right away. I am completely sympathetic to this. In “PrivatKlinik” the reception is carried out by absolutely 3 different gynecologists in character, method of presenting information. And each of us has our OWN patient.
“How is my appointment structured to win over the patient?”
I start the appointment with a short acquaintance, although he also knows my name, and I already know the basic information about the patient from the electronic card, which I look through before the appointment. From the first minutes of the appointment, I try to relieve the patient’s tension with a short, casual conversation on a neutral topic. Not everyone will perceive a smile correctly due to his inner experiences. Therefore, first I will exchange a few words about the weather or say a compliment.Sometimes the patient has a peculiar hairstyle, sometimes a handbag. I am also a woman, I easily note these details and can sincerely admire.
Sometimes you have to start a conversation by explaining the reasons why the reception was delayed. Because medicine is not an exact science, it is very important for me to get the most complete information from the patient in order to help comprehensively. Someone needs more time for this. Or emergency patients often come, unscheduled. It happens that after the reception I focus the patient’s attention, so 40 minutes have already passed with you, and he wonders how the time has flown so quickly.
Next comes the specifics. I always have a clear plan of action at the reception. Standard examination and smears, no one runs away from this. Next comes a general inspection.
I always explain why I assign each analysis, and in accessible human language.
But many find it difficult to understand why to take a smear a second time if I passed it a few months ago and everything is ok. And this is a standard test that will show the presence of inflammation. And I explain all this.I am telling you how this will happen. I also comment on the inspection.
I always find out what they came with and what they want from me. In addition to complaints, I will find out whether they have already addressed a doctor with this and what they received from those appointments or not.
The reason for the request is not always obvious. I try to make the patient speak, and if it is difficult for him, then I describe to him the ideal picture and clarify what he wants. And he agrees or “specifies”. I am fortunate to have a highly developed sense of empathy.Or maybe it’s not a matter of luck, but experience. I understand the emotional state immediately intuitively.
“Are there different management tactics for women in menopause or planning pregnancy, or already pregnant?”
The tactics of communication are no different, I, in principle, always have the same attitude. The tactics of management differ in terms of medicine and treatment. Perhaps the construction of sentences is changing. Because any doctor must be a psychologist.
I always say: I am a female doctor.
I always look at the patient as a woman completely. I don’t look at the uterus or vagina separately, I don’t treat only itching. And I fully examine the woman and select such methods of treatment so that the same chronic diseases are not aggravated by the prescribed therapy. At the same time, I refer to my colleagues in order to rid the patient of other diseases.
Gynecology is a woman as a whole.
The patient may only complain of discharge, but in fact she has deeper problems.
Mandatory question, whether a woman is sexually active. Further, already about the quality of sex life, we are talking at 2 or 3 receptions. Moreover, not every woman knows whether it is good for her or not, whether she is experiencing an orgasm or not. Does he want any changes. Here again, it is important to build trust and learn to listen by asking targeted questions.
But at the same time: If you don’t want to be lied to, don’t ask a lot.
I am asking questions pointwise. For example, I recommend that all patients be checked for infections by asking a question from the instructions: “How many partners do you have now?”It also requires medical intuition and maneuvering.
“Is it necessary to have an orgasm? Is an intimate life necessary for women’s health? ”
I am often asked by patients and subscribers about this. To which, as a doctor, I answer more often – yes, but it all depends on the head.
If a person really wants this, but he does not have it, then, of course, EVERYTHING will affect overall health. And if the head is busy with other ideas, thoughts, a person enjoys life as a whole, then he is fine, and it is not harmful for him, and is not even necessary at this stage of life.
It should not be so that there is only a man nearby, just for physical intimacy. It’s the same with the idea of motherhood. I am always for women, as a female doctor. I try to adhere to the golden mean, this is the life of everyone, I respect the decision of each patient. I am not one of those doctors who insist on childbirth. Although I love children very much. And any gynecologist treats a woman as if she is going to get pregnant tomorrow. But I support the decision of my patients, the only thing is always objectively evaluating.If at the reception a 45-year-old woman says that she is NOT ready to give birth to a child YET, then I will explain that this “for now” may be “already”. But everyone has certain life situations, there is no idea whether or not it is necessary to give birth. Again, the brain is king in everything. If a woman wants a child, but cannot get pregnant, she goes a long way to motherhood, then concomitant diseases, for example, may arise on this basis. And then many doctors will say, that she did not give birth or did not have sexual partners, that is the disease.No. The same diseases can appear in women who live with several sexual partners, have children, but are not happy with their lives, for example, suffering with an alcoholic husband. All the problems are in the head.
“How do I feel about reviews?”
Every doctor mistakenly believes that if the treatment has helped the patient, then he will leave a review and recommend a doctor. But this is not the case. And I’m always embarrassed to say to leave reviews. Although I understand that the patient may not realize how important it is to me.Now everyone is looking for a doctor on the basis of recommendations. And for some, the review can be decisive. For me, the most important thing is the birth of a healthy child, the preservation of the mother’s health and the restoration of the health of all patients! I am always responsible for all my appointments and examinations. Therefore, if there is a misunderstanding, it is better to immediately enter into a dialogue with me than, after a year or two or three, remember that something was not pleasant there at the reception. I have nothing to hide. Sometimes they even write negative reviews, but they come to my appointment, and we give birth to a healthy baby.My attitude will not change in any way towards this patient during the appointment, but what is the purpose of this negative review, I cannot explain to myself.
As a conclusion, I will say that 90% of the treatment result consists of the patient’s trust in the doctor and the doctor’s attention to the patient. My task as a specialist is to build this trust.
And every patient gets maximum attention from me.
90,000 Diagnostics and treatment of rectal prolapse in Moscow
A condition in which there is a bulging of the rectal area (prolapse) from 2 to 20 cm beyond the anal sphincter.Rectal prolapse may be accompanied by pain, incontinence of intestinal contents, mucous and bloody discharge, sensation of a foreign body in the anus, false urge to defecate.
- examination (rectal digital examination)
- sigmoidoscopy, irrigoscopy, manometry.
– violations of the anatomical structure of the pelvic bones, the shape and length of the sigmoid and rectum, pathological changes in the muscles of the pelvic floor
– dolichosigma – an elongated sigmoid colon and its mesentery.It was noticed that in patients with rectal prolapse, the length of the sigmoid colon is on average 15 cm longer, and the mesentery is 6 cm longer than in healthy people. Also, weakening of the pelvic floor muscles and anal sphincter can contribute to rectal prolapse.
What causes rectal prolapse?
– physical overstrain, followed by an increase in intra-abdominal pressure, both once (lifting something heavy) and systematic stress.
– numerous or difficult childbirth (with a narrow pelvis in a woman in labor, a large fetus, multiple pregnancies) and be combined with prolapse of the uterus, vagina, urinary incontinence.
According to the mechanism, the stages of rectal prolapse are distinguished:
- compensated – prolapse occurs during bowel movements and is adjusted independently;
- subcompensated – prolapse occurs with bowel movements and moderate physical exertion; reduction of the prolapsed intestine is possible only with the help of a manual aid; there is an insufficiency of the anal sphincter of the 1st degree;
- decompensated – rectal prolapse may be associated with coughing, laughing, sneezing; accompanied by incontinence of gases and feces, insufficiency of the sphincter II-III degree.
Symptoms of rectal prolapse
Rectal prolapse clinic can develop suddenly or gradually. The first option is characterized by an unexpected onset, most often associated with a sharp increase in intra-abdominal pressure (physical exertion, straining, coughing, sneezing, etc.). During or after such an episode, rectal prolapse develops, accompanied by a sharp pain in the abdomen due to tension in the mesentery.A painful attack can be so severe that it leads to a state of collapse or shock.
Gradual development of rectal prolapse is more common. At first, rectal prolapse occurs only when straining during the act of defecation and is easily eliminated on its own. Gradually, after each chair, it becomes necessary to adjust the rectum with your hand. The progression of the disease leads to prolapse of the rectum during coughing, sneezing, standing upright.
Diagnosis of rectal prolapse
- visual inspection
- sigmoidoscopy, colonoscopy, irrigoscopy, defectography, manometry.
Reduction of the prolapsed intestine leads to the restoration of blood flow and normal appearance of the mucous membrane. If rectal prolapse is not detected at the time of examination, the patient is asked to strain.
With the help of endoscopic examination (sigmoidoscopy), intestinal intussusception and the presence of a solitary ulcer on the anterior rectal wall are easily detected. Colonoscopy is necessary to find out the causes of rectal prolapse – diverticular disease, tumors, etc.If a solitary ulcer is detected, an endoscopic biopsy with cytomorphological examination of the biopsy specimen is performed to exclude endophytic rectal cancer.
By means of irrigoscopy, the presence of anatomical (dolichosigma, intussusception) and functional changes in the colon (colostasis, barium passage disturbances) is determined. The degree of rectal prolapse is specified in the course of defectography – a radiopaque study, in which X-rays are taken at the time of the simulation of the act of defecation.
Anorectal manometry evaluates the function of the muscles surrounding the rectum and their involvement in the process of defecation.
Women with rectal prolapse are shown a consultation with a gynecologist with an examination on a chair.
Treatment of rectal prolapse
Manual reduction of the rectum in case of its prolapse brings only a temporary improvement in the condition and does not solve the problem of rectal prolapse.Pararectal administration of sclerosing drugs, electrical stimulation of the pelvic floor and sphincter muscles also do not guarantee a complete cure for the patient. Conservative tactics can be used for internal prolapse (intussusception) in young people with a history of rectal prolapse no longer than 3 years.
At present, in proctological practice, operations are used for resection of a prolapsed rectal segment, plastic surgery of the pelvic floor and anal canal, resection of the large intestine, fixation of the distal rectum and combined techniques.
Resection of the prolapsed rectum can be performed by circular cutting (according to Mikulich), flap cutting (according to Nelaton), cutting with the imposition of a gathering suture on the muscle wall (according to Delorma), and other methods.
Plastic surgery of the anal canal in case of rectal prolapse is aimed at narrowing the anus using special wire, silk and lavsan threads, synthetic and autoplastic materials. All these methods are rarely used due to the high recurrence rate of rectal prolapse and postoperative complications.The best results are achieved by suturing the edges of the levator muscles and fixing them to the rectum.
In case of an inert rectum, solitary ulcer or dolichosigma, various types of intra-abdominal and abdominal-anal resection of the distal large intestine are performed, which are often combined with fixation operations. In case of necrosis of the intestine, abdominal perineal resection with the imposition of a sigmostomy is performed.
Among the methods of fixation – rectopexy – the most widespread are suturing of the rectum with sutures or mesh to the longitudinal ligaments of the spine or sacrum.Combined surgical techniques for the treatment of rectal prolapse involve a combination of resection, plasty, and fixation of the distal bowel.