Rectal prolapse is a condition where the end of the large intestine moves out of the anus. Prolapse of the rectum is reversible in most patients - displaced parts of the large intestine can be guided back into position. The most advanced forms of rectal prolapse may be permanent. Rectal prolapse is most often caused by a weakening of the pelvic floor muscles, which may be due to a variety of causes. Learn how rectal prolapse manifests itself, what causes rectal prolapse, what complications rectal prolapse can have, and how to diagnose and treat rectal prolapse.

Rectal prolapseis the common name for a medical condition that should actually be called rectal prolapse. The essence of this disease is the loss of the final fragment of the large intestine, i.e. the rectum, outside. The anus itself, or the opening at the end of the digestive tract, remains in place. The displacement of the rectum outside the anus is due to the weakening of the mechanisms that should keep it in the correct position. Weakening of the pelvic floor muscles, abnormal intestinal peristalsis and impaired nerve reflexes can lead to the loss of the end fragments of the large intestine outside the anus.

Rectal prolapse is initially reversible - the displaced section of the intestine can be manually returned to the correct position. Over time, the disease may be progressive - with significant disturbance of the neuromuscular mechanisms supporting the rectum in the correct position, it may lead to a permanent prolapse of the anus.

The human large intestine consists of several fragments - successively of the colon, sigmoid colon and rectum, ending with an anus. The rectum is the last part of the large intestine where feces pass before you have a bowel movement. The proper function of the rectum depends on many factors. The first is the proper activity of the muscles in the intestinal wall responsible for perist altic movements. Their regularity depends, among others, on from a proper diet and hydration. The regular movement of food debris in the large intestine, eventually leading to a bowel movement, also requires proper nervous system function. Defecation, or the act of defecation, is a series of interconnected reflexes. Duringdefecation, some muscles contract, while others relax (including anal sphincters), which allows the faeces to be expelled outside. The pelvic floor muscles, arranged in several layers, play a supporting role for the end fragments of the intestine. Their proper operation - tightening and relaxing, are also necessary for the proper functioning of the end fragments of the digestive tract.

Rectal prolapse - types

There are several forms of rectal prolapse which differ in their severity and clinical symptoms. Rectal prolapse may be full-walled - then the entire thickness of the rectal wall moves outwards.

In the early stages of the disease, as well as in its less severe forms, rectal prolapse may be incomplete. In this case, only a thin mucosa falls out, covering the rectum from the inside.

Prolapse of the rectal mucosa requires differentiation with other diseases, especially with hemorrhoidal disease, because the clinical picture of these entities may be very similar.

Rectal prolapse is primarily associated with external prolapse - then the rectum is visible outside the anus. It is worth knowing that internal rectal prolapse is also possible. As with external prolapse, weakening of the muscles that hold the intestines in position leads to rectal dislocation.

In the case of internal prolapse, however, the rectum does not move outside the anus - it only "slides", but does not fall outside the body. Internal rectal prolapse can be difficult to diagnose - it is also often referred to as "latent prolapse."

Internal rectal prolapse carries the risk of compression of the intestinal wall, leading to ischemia, and in extreme cases - necrosis. Internal rectal prolapse should therefore not be considered a milder variant of this condition. Like external prolapse, it is an indication for surgical treatment.

Rectal prolapse - symptoms

Total rectal prolapse usually first occurs at the time of bowel movement. Rectal prolapse is felt by the patient as the presence of foreign tissue around the anus, which is usually allowed to be manually evacuated to the correct position.

Rectal prolapse can also occur in situations involving increased abdominal pressure, such as coughing, sneezing, laughing, or exercising.

Rectal prolapse may be accompanied by other digestive ailments:

  • chronic constipation,
  • feeling of incomplete defecation,
  • fecal incontinence
  • or episodes of gastrointestinal bleeding.

Similar symptoms may occur with an internal rectal prolapse. It is worth knowing, however, that this variant of rectal prolapse can be completely asymptomatic. If rectal prolapse is accompanied by severe abdominal pain, bleeding or the inability to drain the rectum inwards, an urgent medical consultation is required.

Rectal prolapse - causes

Rectal prolapse is a disease of complex etiology; it is usually due to several reasons. The primary mechanism behind rectal prolapse is the weakening of the pelvic floor muscles, which should normally support the rectum in the correct position.

One of the most common causes of pelvic floor dysfunction is long-term constipation, which occurs in many patients with rectal prolapse. Prolonged, strong pressure on the stool causes the dysfunction of the anal sphincters and weakening of the surrounding muscles and ligaments.

Difficulty in defecation control may also be caused by neurological conditions. The centers of the nervous system that regulate rectal function are located at the bottom of the spinal cord. Injury or damage to this area can lead to excessive flaccidity, and in extreme cases complete paralysis of the pelvic floor muscles. Rectal prolapse may result from such disorders.

Rectal prolapse is thought to affect women 5-6 times more often than men. One of the predisposing factors for rectal prolapse is pregnancy. A large number of pregnancies and deliveries increases the risk of pelvic floor muscle disorders.

The risk of malfunctioning of these muscles also applies to patients who have undergone pelvic surgery. One of the possible complications of such procedures is damage to the nerves responsible for maintaining the proper tone of the pelvic floor muscles.

Rectal prolapse also happens in children. The causes of the disease may be similar to that of the adult population (long-term constipation, neurological disorders) or be associated with other congenital diseases.

One of the characteristic causes of rectal prolapse in children is cystic fibrosis - a genetic disease associated with dysfunction of many organs (including the lungs, pancreas and intestines). Rectal prolapse may, in rare cases, be the first symptom of cystic fibrosis.

Rectal prolapse - complications

Rectal prolapse is a medical condition that requires treatment. While rectal prolapse may initially appear as single episodes, pelvic floor changes become permanent over time.

Rectal prolapse may then be irreversible. Rectal prolapse is always associated with the risk of damage to the mucosa, which may result in infection or bleeding.

Rectal prolapse also leads to the misalignment of the intestine. Some parts of the intestine may overlap, creating a risk of local impairment of the blood supply. Such ischemia of the intestine can cause serious complications - necrosis of the intestinal wall, as well as their perforation, i.e. perforation.

The perforation of the intestine displaces a large amount of bacteria from the lumen of the intestine into the abdominal cavity. These bacteria can cause widespread infections, including peritonitis. Peritonitis is a medical emergency and requires urgent hospital treatment.

Factors causing rectal prolapse may be the cause of other coexisting pelvic dysfunction. Weakening of the pelvic floor muscles can cause the loss of other organs in the vicinity of the rectum.

Prolapse of the anus, especially in women, coexists with prolapse of the reproductive organ or bladder. The treatment of such extensive changes consists in the operational fixing of the organs of the pelvis in their proper position.

Rectal prolapse - diagnosis

A medical history and physical examination of the rectal area (the so-calledper rectum ) allow for the initial diagnosis of rectal prolapse. During the examination, the doctor asks the patient to tighten the abdominal muscles and relax the anal sphincters - similar to pushing on the stool.

If rectal prolapse occurs, the doctor assesses the severity of the symptoms (full-sided vs. incompetent) and the presence of any local complications - for example, bleeding.

Examinationrectalmay be uncomfortable but not painful. This is one of the simplest and most useful tests for anal prolapse.

Initial diagnosis of rectal prolapse is an indication for additional final examination of the large intestine. The anatomy of the rectum is assessed, among others, by in rectoscopy.

Rectoscopy is an examination with the use of a small webcam inserted into the rectum, which allows you to see its interior. To assess the excretory function of the large intestine, a contrast test is performed - the so-called defectography.

This examination consists in administering contrast to the rectum, and then taking a series of X-rays that show the passage of contrast through the rectum (until its expulsion). Defectography can be especially useful in identifying internal prolapserectum.

Additional tests that can complement the diagnosis of rectal prolapse include: transrectal ultrasound, pelvic magnetic resonance imaging, and rectal manometry (measurement of pressure in the anus and rectum).

Rectal prolapse - treatment

The methods of treating rectal prolapse can be divided into conservative and operative. Conservative treatment of rectal prolapse is indicated only in the early stages of the disease. Attempts at conservative treatment are undertaken, among others, by in incomplete rectal prolapse, and also when the probable causes of rectal prolapse are closely related to the patient's lifestyle.

Failures in conservative treatment, advanced forms of rectal prolapse, as well as possible complications of the disease (perforation, major bleeding) are an absolute indication for surgical treatment.

Conservative treatment of rectal prolapse consists in regulating the bowel movement rhythm and training the pelvic floor muscles. One of the main goals of therapy is to avoid constipation. It is advisable to consume plenty of fluids and foods rich in fiber (fresh vegetables, groats, oatmeal, legumes and nuts).

You should also take care of the proper comfort of defecation, avoid rush and increased pressure on the stool. The second aspect of conservative treatment of rectal prolapse is to strengthen the pelvic floor muscles.

Training should take place under the supervision of a qualified physiotherapist. Regular exercise can significantly improve the function of the muscles that hold the rectum in place.

Various types of operations are used in the surgical treatment of rectal prolapse. Each patient requires an individual choice of treatment method, depending on age, anatomical factors, lifestyle and the stage of the disease. Surgical treatment of rectal prolapse can be performed either through the abdominal or through the anus.

Transabdominal surgeries involve attaching a prolapsed fragment of the large intestine to the sacrum. The rectum is fixed with special nets and tapes. Such a procedure is called rectex.

Via the abdominal cavity, it is also possible to perform a partial resection, i.e. excision of a fragment of the large intestine. Some patients use a combination of both of the above methods. It is also worth knowing that some centers perform such operations in a laparoscopic manner.

Then it is not necessary to make large incisions in the abdominal wall - the operation is performed with the use of a camera and tools inserted into the abdominal cavity through small holes.

The second type of treatmentsused in rectal prolapse are transrectal operations. Many of them do not require general anesthesia, so they may be preferred in elderly patients or patients with comorbidities.

Rectal access surgery most often involves cutting a protruding part of the rectum out and then attaching the remainder to the large intestine. In the case of significant widening of the anal canal, it can be narrowed with special sutures.

Doing so can also prevent recurrence of rectal prolapse. Transrectal surgeries have a higher risk of symptom recurrence compared to abdominal surgeries. Their main advantage, however, is that the procedure is much less invasive.

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Category:

Gastrology