Rectal Prolapse

The rectum is a part of the gastrointestinal system. Muscles hold the rectum at its position. Rectal prolapse involves the displacement of the rectum from its original place and protrudes out through the anus. The patient may have a rectum coming out from the anus (known as external prolapse). The rectum may fall into the anus but not come out from the anus ( known as internal or incomplete prolapse). Surgery is usually the treatment option.

Causes

There are several causes of rectal prolapse:

Gastrointestinal problems: If you suffer from gastrointestinal problems, such as chronic diarrhoea and constipation, you are at high risk of rectal prolapse. Persistent straining during a bowel movement also results in rectal prolapse. 

Anal sphincter weakening: Anal sphincter is the muscular structure that regulates the bowel movement from the rectum to the anus. Weakening of the anal sphincter results in rectal prolapse.

Nerve damage: Several muscles in the rectum and anus control bowel movements. Damage to the nerves controlling these muscles cause rectal prolapse. Conditions that may cause nerve damage are spinal injury, pregnancy, paralysis of the anal sphincter, and vaginal birth.

Older age: As you grow older, the muscles controlling the movement of the rectum and anus weaken. It may also cause rectal prolapse. 

Underlying medical conditions: Other underlying medical diseases that may cause rectal prolapse are parasitic infection, malnutrition, chronic obstructive pulmonary disease, cystic fibrosis, and diabetes.

Many people experience a reddish mass bulging out from the anus during or after the bowel movement. It may indicate rectal prolapse. During the initial period of this condition, the rectum goes inside of its own. However, as the disease progresses, you may feel that the rectum is falling out of the anus. In such cases, the doctor adjusts the rectum to its place by pushing it inside.

The other symptoms of rectal prolapse are:

1. Rectal bleeding
2. Anal or rectal pain
3. Leakage of mucus or blood from the rectum
4. Diarrhoea or constipation
5. Feeling that rectum is not completely emptied after a bowel movement

Diagnosis

There are several methods to diagnose rectal prolapse. Some of them are:

Rectal examination: The doctor may comprehensively examine the rectum and ask you to sit and mimic the bowel movement to determine the presence of rectal prolapse and consider the other symptoms, such as bowel incontinence or bladder prolapse.

Anal ultrasound: The doctor performs the anal ultrasound to determine the health of muscles and tissues of the rectum. During the anal ultrasound, the doctor inserts a probe into the rectum to capture images.

Magnetic resonance imaging: The doctor may also recommend the patient to undergo a rectal MRI. It will help the doctor to analyse the pelvic organs.

Colonoscopy: The doctor inserts a flexible tube into the rectum with a camera at the top. The doctor views the rectum and colon internally and rules out colon cancer or polyps.

Proctosigmoidoscopy: The doctor also performs proctosigmoidoscopy to evaluate the health of the anus and sigmoid colon. Through this test, the doctor rules out inflammation or scarring.

Anal manometry: The doctor performs the anal manometry to determine the strength of the anal sphincter and sensitivity of the rectum.

Defecography: The doctor performs this test through contrast imaging. This test will help the doctor analyse the rectal muscles' functioning.

Treatment 

The doctor has the following options to manage the rectal prolapse:

1. Medicines: The doctor may prescribe the medicine during the initial stages of the rectal prolapse. These medications reduce the excessive stretching of muscles during bowel movements. These medicines include stool softeners, drugs for managing constipation, and suppositories.
2. Surgery: Surgery is the most common option for managing rectal prolapse. The primary goal of the surgery is to place the rectum back into its original position. Various types of surgeries manage rectal prolapse. The doctor may recommend the type of surgery depending on age, overall health and severity of the rectal prolapse. The main types of surgery are:
3. Abdominal Surgery: The doctor performs this surgery under general anaesthesia. The patient may undergo open surgery or surgery through laparoscopy. The doctor performs the surgery in the abdominal cavity to fix the displaced rectum. The doctor may also remove a part of the intestine in patients with severe constipation before fixing the rectum.
4. Perineal Surgery: This procedure involves a rectal repair approach. The doctor usually uses this method in older patients with other medical conditions. The patients undergo this procedure under spinal anaesthesia. There are two types of perineal surgery, i.e., the Altemeier procedure and the Delorme procedure. Altemeier procedure is also known as perineal proctosigmoidectomy. The doctor in this method cuts the part of the rectum which is protruded outside the anus. The two ends are then joined. In the Delorme procedure, the doctor only removes the inner lining of the protruded rectum. The surgeon then folds the outer layer and joins it with the edges of the inner layer so that the complete rectum is placed inside the anus.

Rectal prolapse surgery relieves symptoms and improves fecal incontinence and constipation.