Rectal Prolapse

What is a rectal prolapse?
Rectal prolapse is a condition in which the rectum (the lower end of the colon, located just above the anus) becomes stretched out and protrudes out of the anus. Weakness of the anal sphincter muscle is often associated with rectal prolapse, sometimes resulting in faecal incontinence (leakage of stool). The condition occurs in both sexes, but it is much more common in women.

Why does it occur?
Several factors may contribute to the development of a rectal prolapse. It may come from a lifelong habit of straining to have bowel movements or as a late consequence of the childbirth process. It seems to be a part of the aging process with stretching of the ligaments that support the rectum inside the pelvis as well as weakening of the anal sphincter muscle. Sometimes rectal prolapse results from generalized pelvic floor weakness, in association with urinary incontinence and vaginal / uterine prolapse as well.

Is rectal prolapse the same as haemorrhoids?
 Some of the symptoms may be the same: bleeding and/or tissue that protrudes from the rectum. Rectal prolapse, however, involves a segment of the bowel located higher up within the body, while haemorrhoids develop near the anal opening.

How is rectal prolapse diagnosed?
A careful history and examination are required. To demonstrate the prolapse, patients may be asked to sit on a commode and "strain" as if having a bowel movement. Occasionally, a rectal prolapse may be "hidden" or internal, making the diagnosis more difficult. In this situation, an x-ray examination called a defaecating proctogram may be helpful. Anorectal manometry may also be used to evaluate the function of the muscles around the rectum.

How is rectal prolapse treated?
Although constipation and straining may contribute to the development of rectal prolapse, simply correcting these problems will not improve the prolapse once it has developed. There are many different ways to surgically correct a rectal prolapse. Abdominal or rectal surgery may be suggested. An abdominal repair (rectopexy) may be approached laparoscopically in selected patients. The decision to recommend an abdominal or rectal surgery takes into account many factors, including age, physical condition, extent of prolapse and the results of various tests. A rectal (or ‘perineal’) repair is often undertaken in elderly or unfit patients.

How successful is treatment?
A great majority of patients are completely relieved of symptoms, or are significantly helped, by the appropriate procedure. Success depends on many factors, including the status of a patient's anal sphincter muscle and pelvic floor muscles before surgery. If the anal sphincter muscles have been weakened, they may have the potential to regain some strength after the rectal prolapse has been repaired but it may take up to a year to determine the final impact of the surgery on bowel function. Chronic constipation and straining after surgical correction should be avoided.

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