Anal prolapse is a prolapse of the anus. This causes the anal canal to protrude from the anus.
What is anal prolapse?
Anal prolapse is understood as a prolapse of the anus. This causes the anal canal to protrude from the anus. Anal prolapse is a prolapse of anal canal skin and mucosa in the external direction. It is caused by defecation or heavy pressing before it. In this case, the anal skin is not sufficiently attached to the sphincter muscle, which is located under it. Following defecation, there is retraction of the anal canal. Leakage of the canal can also result from lifting heavier weights, sneezing or coughing. If, in addition, parts of the rectum or rectum protrude from the anus, it is called rectal prolapse or rectal prolapse. In principle, anal prolapse can occur at any age. However, older people are particularly affected. This primarily includes women.
Causes
Several causes are possible for the occurrence of anal prolapse. The main reason is weak pelvic floor muscles in affected individuals. In children, anal prolapse shows up very rarely and usually occurs before the age of three. In most cases, prolapse is caused by underlying diseases such as cystic fibrosis. The reason for anal prolapse in adults is usually the general sagging of the pelvic floor. This can also cause prolapse of other organs. These include the urinary bladder or the uterus. It is not uncommon for pelvic floor damage to occur in women as a result of childbirth. This also increases the risk of age-related prolapse. There are also some risk factors that increase the likelihood of anal prolapse. These include chronic constipation as well as increased defecation pressure. The muscles of the pelvic floor then no longer have enough strength to counteract prolapse. Other risk factors include injuries to the sphincter muscle, congenital malformations, gynecologic surgery, neurologic damage to the pelvic nerves, and inflammation and tumors.
Symptoms, complaints, and signs
Pain rarely occurs with anal prolapse. Instead, palpable portions of bowel or folds of mucous membrane protrude from the anus. Sometimes the portions may slide back on their own. It is also possible to push them back with the hand. Some patients also experience severe itching in the anal area. Since the sphincter muscle is also affected by anal prolapse, fecal incontinence is not uncommon, so that defecation can usually no longer be controlled. As a result, those affected pass stool without wanting to. However, the intensity of the incontinence varies. For example, it is less severe in anal prolapse than in rectal prolapse. Another possible symptom is mechanical irritation of the mucosa that leaks in anal prolapse. In turn, the frictional forces can cause inflammation and bleeding. Sometimes ulcers also form. Likewise, a discharge of mucus and blood from the anus is conceivable. As the symptoms become more pronounced as the disease progresses, it is important to start medical treatment quickly.
Diagnosis and course
In most cases, the mere glance of an experienced physician is sufficient for the diagnosis of anal prolapse. This person can also distinguish whether it is an anal prolapse or a rectal prolapse. Further examinations are also possible for confirmation as well as for a better estimation of the extent of the disease. This may involve sonography (ultrasound examination) or endoscopy of the lower bowel. If the exact degree of prolapse cannot be assessed, a defecogram is performed. This requires the patient to defecate under X-ray control. Since this examination is very unpleasant for the patient, it is performed only in rare cases. Anal prolapse is not life-threatening. However, it can usually only be treated effectively by surgery. Surgery can usually successfully correct the prolapse.
Complications
Anal prolapse causes the anal canal to protrude involuntarily from the anus. The symptom progresses to its final appearance in varying stages and does not manifest until later in life.Excessive pressing during defecation can damage the anal canal to such an extent that even minimal movements can lead to prolapse. Weakness of the connective tissue is suspected as the pathogenesis. This may be genetic, but may also occur in families with hemorrhoids and fecal incontinence. In women, there may be a weakening of the pelvic floor due to childbirth, which latently promotes the symptom. Women and the elderly are more likely to suffer from anal prolapse than children. If the symptom is not treated in time, significant complications occur. The anal canal may protrude widely from the anus. In addition, the condition spreads to the rectum and rectum. The patient experiences pain, incontinence and a severe loss of quality of life. Usually, the bowel can be pushed back as a medical measure. If this does not succeed, emergency surgery is initiated. The patient then receives drug therapy as well as physiotherapeutic pelvic floor exercises to prevent subsequent complications. Depending on the severity of the prolapse, dietary habits must be consistently changed to keep bowel movements soft. If diagnosed in time, the chances of recovery increase.
When should you go to the doctor?
If parts of the intestine can be felt at the anus after defecation, a doctor should be consulted. The medical professional can usually determine at a glance whether anal prolapse is involved. Depending on the diagnosis, appropriate treatment can then be initiated, which should cause the prolapse to regress quickly. However, if anal prolapse remains untreated, significant complications can occur. Among other things, pain, incontinence and diseases of the rectum and rectum can occur. If anal prolapse has already progressed to the point where serious health problems occur, an emergency physician must be consulted. In most cases, the anal canal must then be repositioned by emergency surgery. To avoid this, a visit to the doctor is recommended at the first signs of anal prolapse. Patients with hemorrhoids, cystic fibrosis, chronic constipation, inflammation or tumors must discuss abnormalities at the anus immediately with the doctor in charge. Medical advice is required at the latest in the event of fecal incontinence or a visible part of the bowel at the anus.
Treatment and therapy
In most cases, anal prolapse is treated surgically. Only occasionally can surgical intervention be avoided. In children, treatment of the triggering underlying disease is usually sufficient. If surgery is required, a distinction is made between two methods. The operation is performed either from the anus or through the abdominal cavity. An operation through the abdominal cavity is a laparoscopy (laparoscopy) or a laparotomy, in which an open abdominal incision is made. In this procedure, the rectum is fixed in such a way that sagging is no longer possible. For this purpose, the surgeon sutures the intestine at the level of the sacrum. Sometimes a net made of plastic can also be used to fix the intestine. In some cases, it is also necessary to tighten certain areas of the colon. If the surgical procedure is performed from the anus, the intestine that has come out is removed by the doctor. Then the two ends of the intestine are pushed back and sutured. In principle, surgery via the abdominal cavity is considered more efficient because the risk of subsequent complications is lower. However, the surgical risk for the patient is lower with an operation at the anus, but this also applies to the chances of success. Therefore, a good balance must be struck between the two procedures. Following the operation, the patient receives special medication. He must also follow a specific diet plan. This serves to keep the stool soft.
Outlook and prognosis
As a rule, anal prolapse causes severe pain or other discomfort only in rare cases. In this case, those affected can usually push the parts of the anus or bowel back in themselves, and in many cases they slide back in on their own. Furthermore, many patients with anal prolapse also experience severe itching and redness of the skin. If the affected person scratches the respective area, the itching is intensified. It is not uncommon for patients to also suffer from fecal incontinence, which has a very negative effect on everyday life and quality of life. It is not uncommon for psychological complaints or depression to occur.Bleeding or inflammation may also occur, which can be painful. An ulcer can also develop. If the symptoms do not disappear on their own, the affected person should definitely consult a doctor. As a rule, life expectancy is not reduced by this disease. With the help of a surgical intervention, the complaints can be alleviated. The further course usually depends on the underlying disease. Further complaints or complications usually do not occur.
Prevention
The best preventive measure against anal prolapse is early completion of gymnastic exercises to strengthen the pelvic floor, which should take place under the guidance of experts. In this way, the perineum and anus can be strengthened. It is also important to avoid constipation.
Aftercare
Anal prolapse is corrected by surgery in many cases, but it can also be treated conservatively. In both cases, consistent follow-up is important for two reasons. On the one hand, it is important to regenerate therapy consequences such as a wound from surgery as best as possible. On the other hand, targeted measures should be taken to prevent the recurrence of anal prolapse. In both cases, follow-up care can be provided by the general practitioner or the treating proctologist. The patient is also involved in follow-up care by reporting symptoms such as difficult bowel movements or pain or bleeding in the anal area to his or her doctor as soon as possible. A bowel movement that is not too hard is the most important aftercare and prevention at the same time. Heavy pressing during bowel movements must be avoided at all costs, as anal prolapse often develops for this reason. Therefore, sufficient drinking is just as important as a diet rich in fiber. The stool can be kept soft and voluminous with psyllium husks as a proven home remedy. In addition to stool regulation, aftercare also includes the care of any surgical wound. This is done according to the doctor’s instructions. Later, thorough hygiene is also important. However, harsh detergents and damp toilet paper are not recommended. Lukewarm water is sufficient in many cases. Dry dabbing with soft paper is important, as bacteria particularly prefer moist environments.
What you can do yourself
Anal prolapse often severely limits the quality of life of those affected. Many patients are embarrassed by their suffering and therefore delay a visit to the doctor. This should be avoided in any case. The sooner anal prolapse is diagnosed and treated, the better the chances of successful therapy. At the latest when uncontrolled defecation has occurred for the first time, a doctor must be consulted. An anal canal prolapse can usually only be treated surgically. However, since weakness of the pelvic floor muscles is usually responsible for the anal canal and, if necessary, parts of the bowel not being held inside the body, special exercises can help prevent the problem or prevent the symptoms from returning after surgery. A healthy diet and regular exercise can prevent additional risk factors, such as permanent constipation. Women suffer from anal prolapse much more often than men, which is why a connection with pregnancy and (natural) childbirth is suspected. Women can therefore influence this risk by the number of births and the choice of birth method. If uncontrolled defecation occurs during everyday situations, such as coughing or heavy lifting, special diapers from medical supply stores can help sufferers feel more secure again.
