Rectal Prolapse

Rectal prolapse is a medical condition in which the rectum starts to push through the anus. The rectum is that last part of your large intestine, and the anus is the opening through which stool exits your body.

Rectal prolapse can range from mild to severe. Mild cases can often be treated without surgery. Severe cases may require surgery.

Symptoms

The symptoms of rectal prolapse tend to come on slowly. 

1. The first symptom you will notice is the feeling that there is a bulge at your anus. It may seem as though you are sitting on a ball.

2. With a mirror, you may be able to see a reddish-colored bulge peeking through or extending out of your anus. Sometimes during a bowel movement, a small part of the rectum will emerge, but may retreat on its own or be easily pushed back into place.

3. Normal physical activity, such as walking, sitting, and exercising, may also cause part of the rectum to push through your anus. At first, it can be returned to its proper location by hand.

4. If rectal prolapse worsens, there could be bleeding from the inner lining of the rectum. In cases of partial or complete prolapse, you may have trouble controlling liquid or solid bowel movement and gas from your rectum.

5. Up to half of the people with rectal prolapse experience constipation, while others may have episodes of constipation and incontinence

Types

There are three types of rectal prolapse. The type is identified by the movement of the rectum:

1. Internal prolapse: The rectum starts to drop but has not yet pushed through the anus.

2. Partial prolapse: Only part of the rectum has moved through the anus.

3. Complete prolapse: The entire rectum extends out through the anus.

Causes

Rectal prolapse can be caused by several medical conditions: 

1. Nerve damage: If nerves that control the rectal and anal muscles are damaged, rectal prolapse can develop.

2. Weakened anal sphincter: This is the muscle that allows stool to pass from your rectum

3. Chronic constipation: The strain of chronic bowel movement problems can make your rectum more likely to move down from its location. Strain while having bowel movements, if done often over a period of years, can also cause rectal prolapse.

Diagnosis

You would describe your symptoms to your doctor. A complete physical examination is done as well. During your exam, your doctor may ask you to squat and strain as though you were having a bowel movement. Your doctor will observe your rectum and may place a gloved finger in your anus to check the health or strength of the anal sphincter and the rectum itself.

Treatment

Rectal prolapse will not get better on its own. The degree of prolapse will increase over time. This process can take months or years, so there is not always a rush to make a decision.

If you have been diagnosed with rectal prolapse, you may choose to delay treatment if your symptoms are mild enough and your quality of life is not significantly hampered.

Surgery is the only way to effectively treat rectal prolapse and relieve symptoms. The surgeon can do the surgery through the abdomen or through the area around the anus.

Surgery through the abdomen is performed to pull the rectum back up and into its proper position. It can be done with a large incision and open surgery, or it can be done laparoscopically, using a few incisions and specially designed smaller surgical tools.

Surgery from the region around the anus involves pulling part of the rectum out and surgically removing it. The rectum is then placed back inside and attached to the large intestine. This approach is usually performed in people who are not good candidates for surgery through their abdomen.

Prevention

Preventing rectal prolapse is not always possible. You can reduce your risk if you maintain good intestinal health. To help avoid constipation, in particular:

1. make high-fiber foods part of your regular diet, including fruits, vegetables, bran, and beans

2. reduce the amount of processed food in your diet

3. drink plenty of water and fluids every day

4. exercise most, if not all, days of the week

5. manage your stress with meditation or other relaxation techniques

Advantage:

The primary advantages of a transabdominal procedure are:

 the lower recurrence rates 

and the associated improvements in incontinence 

as well as the preservation of a rectal reservoir. 

Disadvantages:

are that they are a more invasive procedures and do have an associated risk of postoperative sexual dysfunction in males.