Rectal Prolapse

Definition

Rectal prolapse is protrusion of rectal tissue through the anus to the exterior of the body. The rectum is the final section of the large intestine.

Description

Rectal prolapse can be either partial or complete. In partial prolapse, only the mucosa layer (mucous membrane) of the rectum extends outside the body. The projection is generally 0.75-1.5 in (2-4 cm) long. In complete prolapse, called procidentia, the full thickness of the rectum protrudes for up to 4.5 in (12 cm).

Rectal prolapse is most common in people over age 60, and occurs much more frequently in women than in men. It is also more common in psychiatric patients. Prolapse can occur in normal infants, where it is usually transient. In children it is often an early sign of cystic fibrosis or is due to neurological or anatomical abnormalities.

Although rectal prolapse in adults may initially reduce spontaneously after bowel movements, it eventually becomes permanent. Adults who have had prior rectal or vaginal surgery, who have chronic constipation, regularly depend on laxatives, have multiple sclerosis or other neurologic diseases, stroke, or paralysis are more likely to experience rectal prolapse.

Causes and symptoms

Rectal prolapse in adults is caused by a weakening of the sphincter muscle or ligaments that hold the rectum in place. Weakening can occur because of aging, disease, or in rare cases, surgical trauma. Prolapse is brought on by straining to have bowel movements, chronic laxative use, or severe diarrhea.

Symptoms of rectal prolapse include discharge of mucus or blood, pain during bowel movements, and inability to control bowel movements (fecal incontinence ). Patients may also feel the mass of tissue protruding from the anus. With large prolapses, the patient may lose the normal urge to have a bowel movement.

Diagnosis

Prolapse is initially diagnosed by taking a patient history and giving a rectal examination while the patient is in a squatting position. It is confirmed by sigmoidoscopy (inspection of the colon with a viewing instrument called a endoscope) Barium enema x rays and other tests are done to rule out neurologic (nerve) disorders or disease as the primary cause of prolapse.

Treatment

In infants, conservative treatment, consisting of strapping the buttocks together between bowel movements and eliminating any causes of bowel straining, usually produces a spontaneous resolution of prolapse. For partial prolapse in adults, excess tissue is surgically tied off with special bands causing the tissue to wither in a few days.

Complete prolapse requires surgery. Different surgical techniques are used, but all involve anchoring the rectum to other parts of the body, and using plastic mesh to reinforce and support the rectum. In patients too old, or ill, to tolerate surgery, a wire or plastic loop can be inserted to hold the sphincter closed and prevent prolapse. Treatment should be undertaken as soon as prolapse is diagnosed, since the longer the condition exists, the more difficult it is to reverse.

Alternative treatment

Alternative therapies can act as support for conventional threatment, especially if surgery is required. Acupuncture, homeopathy, and botanical medicine can all be used to assist in resolution of the prolapse or in recovery from surgery.

Prognosis

Successful resolution of rectal prolapse involves prompt treatment and the elimination of any underlying causes of prolapse. Infants and children usually recover completely without complications. Recovery in adults depends on age, general health, and the extent of the prolapse.

Prevention

Reducing constipation by eating a diet high in fiber, drinking plenty of fluids, and avoiding straining during bowel movements help prevent the onset of prolapse. Exercises that strengthen the anal sphincter may also be helpful.