Brief overview
- Symptoms:Anal canal bulges outward (under pressure)
- Treatment: Avoid constipation, do not exert excessive pressure during bowel movements, depending on severity, surgical treatment is recommended.
- Diagnosis: On the basis of the symptoms, visual and palpation examination, possibly rectoscopy, X-ray examination.
- Prognosis: Early treatment reduces the risk of complications and a worsening of the symptoms; as a rule, patients are symptom-free again after surgery.
- Prevention: balanced diet for normal bowel movements, avoid constipation, sufficient exercise, early treatment by a doctor
What is anal prolapse?
Anal prolapse usually proceeds in stages. At first, prolapse of the anal canal occurs only when sufferers push hard on the toilet. After defecation, the anal canal retracts again. In the further course, a prolapse of the anus already occurs during coughing or large lifting efforts.
You can learn more about rectal prolapse in our article Rectal prolapse.
Doctors usually recognize anal prolapse at first glance, as only a few folds of skin protrude from the anus. Those affected often also have hemorrhoids. If pronounced hemorrhoids are present, the distinction from anal prolapse tissue is not so easy in some cases. However, if entire mucosal bulges have prolapsed, it is no longer anal prolapse but rectal prolapse.
Most often, sufferers notice that a piece of bowel is turned inside out. In some people, this is only temporary when there is strong pressure, such as on the toilet or heavy lifting. In others, the bowel remains permanently turned inside out.
In some cases itching occurs, and in some cases bowel incontinence occurs. How pronounced the incontinence is depends on the extent of the prolapse. In anal prolapse, it is usually not as pronounced as in rectal prolapse. In addition, the exposed intestinal mucosa produces fluid incessantly, so in addition to incontinence, patients feel that they are constantly wet. In some cases, bleeding of the mucosa occurs.
How is anal prolapse treated?
The treatment of anal prolapse depends on the severity. Only in rare cases is it a mild form of anal prolapse that does not require surgery, at least initially. In many cases, however, the doctor recommends surgery, especially if incontinence is present. In children, surgery is usually not necessary. Here, consistent treatment of the underlying disease (such as cystic fibrosis) is usually also the best therapy for anal prolapse.
Non-surgical treatment options
If there is mild anal prolapse, it retracts on its own or can be pushed back, an alternative, non-surgical therapy can be considered. Doctors recommend various measures here to support healthy digestion:
- Eat enough dietary fiber
- Drink enough fluids
- Sit less
- Move a lot
Surgical treatment options
- Surgery via the abdominal cavity: Surgery via the abdominal cavity is performed either via an abdominal incision (laparotomy) or a laparoscopy. In this procedure, the doctor fixes the rectum in such a way that it is no longer possible for it to sag down. He sutures the intestine at the level of the sacrum (rectopexy), and in some cases a plastic net holds the intestine in the desired position. Sometimes the surgeon has to remove a certain section of the colon for tightening (sigmoid resection).
Overall, if surgery is performed via the abdominal cavity, the risk of recurrence of anal prolapse is lower. However, with this surgical method there is a higher risk of complications occurring during or after the operation.
For the operations, in most cases, the patients stay in the hospital for a few days. Whether the operations are to be performed under general or partial anesthesia and how long the hospital stay is planned depends on various factors. For example, on what the health condition of the affected person is.
How does anal prolapse occur and are there risk factors?
The causes of anal prolapse are varied. Weak pelvic floor muscles play an important role. This is therefore also an important starting point in therapy and aftercare.
In adults, a general sagging of the pelvic floor is often causative, so that in some cases other organs, such as the uterus or bladder, also prolapse. Occasionally, for example, the birth process causes damage to the pelvic floor, increasing the risk of anal prolapse in old age.
- Hemorrhoids of high severity
- Neurological damage to the nerves in the pelvis
- Injuries of the sphincter muscle
- Gynecological interventions
- Congenital malformations
- Inflammations
- Tumor diseases
How is anal prolapse diagnosed?
If incontinence and the degree of anal prolapse cannot be assessed, doctors may in rare cases suggest a so-called defecogram. This involves the patient defecating under X-ray fluoroscopy. However, this examination, which is very unpleasant for the patient, is not the rule and is only used for special questions.
What is the prognosis for anal prolapse?
The earlier anal prolapse is detected and treated, the better the chances of recovery and the lower the possible risks. Anal prolapse is only life-threatening in rare cases. The bowel can usually be pushed back, and there is no clamping. If this does happen, emergency surgery is necessary in rare cases to prevent the death of the section of bowel that has fallen out.
Especially for younger patients, doctors recommend the procedure through the abdominal wall. In older people, they weigh the usually high surgical risk for such a major procedure.
After the procedure, anal prolapse is usually resolved. Nevertheless, it is important that affected persons pay attention to the following aspects afterwards:
- Pay attention to a balanced diet
- Prevent possible constipation at an early stage
- Strengthen the pelvic floor through sport
How do you prevent anal prolapse?
There are measures to reduce the influenceable risk factors for anal prolapse. One of the main causes of anal prolapse is high pressure on the rectum. For this reason, it is advisable to pay attention to a balanced diet and healthy digestion. Diarrhea, constipation as well as heavy pressing on the toilet should be avoided as far as possible.
At the same time, there are many factors such as age, gender or other diseases that increase the risk of anal prolapse, but they cannot be influenced.
