What is Rectal Prolapse?
Rectal prolapse is a condition in which the rectum, which is the last portion of the large intestine, protrudes outside the anus. This occurs when the rectum turns itself inside out and extends through the anal opening. Rectal prolapse can range from mild, where the rectum protrudes only during bowel movements and returns to its normal position afterward, to severe, where the rectum remains permanently prolapsed.
There are three main types of rectal prolapse:
Mucosal prolapse (partial prolapse): Only the inner lining of the rectum (mucosa) protrudes through the anus during bowel movements but returns to its normal position afterward.
Partial prolapse: The rectal lining and a portion of the rectum itself protrude through the anus during bowel movements and may retract spontaneously or require manual repositioning.
Complete prolapse: The entire thickness of the rectal wall protrudes through the anus and remains outside the body. In severe cases, this may occur with or without bowel movements and may require manual reduction or surgery to correct.
Risk Factors for Rectal Prolapse
Rectal prolapse can be caused by various factors, including:
- Weakening of the muscles and ligaments that support the rectum and pelvic floor, often due to aging, childbirth, or repeated straining during bowel movements (as in chronic constipation).
- Chronic constipation or diarrhea, which can increase intra-abdominal pressure and strain the pelvic floor muscles.
- Conditions that affect the pelvic floor muscles or nerves, such as pelvic floor dysfunction or neurological disorders.
- Previous pelvic or rectal surgery.
Symptoms of Rectal Prolapse
Symptoms of rectal prolapse may include:
- Rectal protrusion during bowel movements, which may be associated with pain or discomfort.
- Tissue protruding from the anus that may need to be manually pushed back into place.
- A feeling of incomplete bowel emptying.
- Anal bleeding or mucus discharge.
- Difficulty with bowel movements or urinary incontinence (especially in severe cases).
Treatment for Rectal Prolapse
The treatment of rectal prolapse depends on the severity of the condition, the patient's overall health, and individual preferences. Treatment options may include:
- Lifestyle Modifications: Making changes to your diet and bowel habits can help manage symptoms and reduce the risk of worsening rectal prolapse. This may include increasing fiber intake to prevent constipation, staying hydrated, and avoiding straining during bowel movements.
- Pelvic Floor Exercises: Physical therapy and pelvic floor exercises, such as Kegel exercises, can help strengthen the muscles that support the rectum and pelvic floor, potentially improving symptoms and reducing the risk of prolapse recurrence.
- Medications: In some cases, medications such as stool softeners or laxatives may be prescribed to relieve constipation and reduce straining during bowel movements, which can aggravate rectal prolapse.
- Biofeedback Therapy: Biofeedback therapy involves using electronic sensors to monitor muscle activity in the pelvic floor and teach patients how to improve muscle coordination and control, potentially reducing symptoms of rectal prolapse.
Surgical Treatment for Rectal Prolapse
Surgery may be recommended for more severe or symptomatic cases of rectal prolapse that do not respond to conservative treatments. There are several surgical approaches to rectal prolapse, including:
Rectopexy: This procedure involves surgically attaching the rectum to the surrounding tissues or the sacrum (the bone at the base of the spine) to provide support and prevent prolapse.
Resection with or without Rectopexy: In cases where the rectum is extensively prolapsed or damaged, surgery may involve removing a portion of the rectum (resection) and reattaching the remaining rectum to the sacrum (rectopexy).
Ventral Mesh Rectopexy: Ventral mesh rectopexy is a surgical procedure used to treat rectal prolapse and certain cases of rectal or pelvic floor dysfunction. In this procedure, a synthetic mesh is used to provide support to the rectum and pelvic floor, helping to prevent the rectum from prolapsing or descending into the anus.
Perineal Procedures: Perineal approaches involve accessing and repairing the rectal prolapse through an incision made in the rectal wall itself avoiding the need for abdominal surgery. Examples include the Delorme procedure and the Altemeier procedure.
The choice of surgical procedure depends on a number of factors including both the extent of prolapse and the patient's overall health. Your Colorectal Surgeon has specialized training and experience to balance the risks, benefits, and potential outcomes of surgery to help make an informed decision about the most appropriate treatment approach for your individual case.