ABOUT Rectal Prolapse - Treatment, Diagnosis, Causes & Symptoms
What Is Rectal Prolapse?
Rectal prolapse is an event in which the rectum, or
large intestine, slips out of place and protrudes through the anus. Prolonged
straining during defecation (such as sitting on number two for days at a time)
can make this condition more likely to develop.
Prognosis
If the prolapsed tissue is pushed back into place
before it becomes strangulated, recovery will be likely to occur with good
medical care. However, if strangulation occurs, surgery may be necessary to
suture the tissue back into place.
The prognosis for recovery of bowel function after
surgery ranges from 5% to 80%. If there has been significant damage caused by
severe straining over many years... a patient's quality of life may be
significantly reduced if restoration of normal bowel function does not occur.
A new theory suggests that some patients with rectal
prolapse have a weakened pelvic floor due to the overuse of intra-abdominal
pressure as a way to control incontinence. In this study, researchers found that
some patients also encountered difficulty in emptying the rectum, an issue
often associated with those who develop fecal incontinence.
Rectal prolapse which is treated by surgery is called
"treated rectal prolapse". The surgery is called "surgical rectal
prolapse repair".
When the rectum enters the pelvis, it swells and can be
felt as a mass in the lower abdomen. The prolapse occurs when the muscle tissue
surrounding the anus becomes weak and can no longer support the rectum, with it
slipping through as a result.
Currently, there is no established risk factor for this
condition; however, prolonged use of hard toilet seats has been linked to this
phenomenon.
The muscles of those with idiopathic fecal incontinence
may be vulnerable to mild collagen damage which causes weakness and perforation
of these muscles. The actual mechanism of prolapse is unclear.
A physician can diagnose rectal prolapse during a
physical examination by observing the weakened muscles and the presence of an
abdominal mass. Additional tests such as proctography, anorectal manometry can
be done to diagnose this condition and if possible its cause.
A proctoscope, a long thin flexible lighted tube, can
also be used to view the condition and determine if surgery is needed.
Prognosis is dependent on the severity of the prolapse; those with milder cases tend to recover quickly with medical treatment whereas those who have undergone long periods of constipation will likely need surgery for a permanent repair.
Frequently Asked Questions On Rectal Prolapse
What Is Surgical Intervention For Symptomatic Rectal Prolapse?
Surgical intervention for symptomatic rectal prolapse
often requires the use of permanent sutures. Sutures are used to provide
additional support to the weakened muscles by creating a hammock to prevent
further prolapse.
Rectal prolapse is most commonly repaired using the
procedure described by Lichtenstein et al. The procedure is performed under
general anesthesia and involves fixation of the prolapsed structure with
permanent sutures that are placed through the mesentery of the rectum around
the anus.
How Common Is It?
Prolapse of the rectum is a relatively common
condition, occurring in about 10% of the population. The number of patients
with symptomatic prolapse appears to be increasing with time (Phillpot et al.,
2010).
The cause of this increase in incidence is unclear;
however, one theory suggests that it is due to an increase in straining during
defecation, with chronic constipation leading to prolapse (Phillpot et al.,
2010).
The mechanism(s) whereby prolapse causes symptoms is
largely unknown. It has been postulated that mild or severe constipation causes
perirectal nerve compression and the resultant weakness which then causes
compression of the rectal wall (Robertt, 2008).
When Can I Expect To Resume My Regular Activities And How Long Before I See Results?
Immediately after surgery, you may begin walking and
sitting in a chair. It will take 4-6 weeks for your bowel movements to return
to normal. It will take 2-3 months before you notice a significant difference
in stool consistency and your ability to control your bowels without leakage or
urge incontinence.
