Brief overview
- Treatment: depends on severity, usually surgical treatment is necessary
- Symptoms: Oozing, itching, stool smearing, partial incontinence, defecation disorders, bleeding
- Causes and risk factors: Pelvic floor weakness, age, female gender, digestive disorders (chronic constipation or diarrhea)
- Diagnosis: Medical history and physical examination, rectoscopy, ultrasound, rarely magnetic resonance imaging.
- Course of disease and prognosis: Usually not a life-threatening disease, relief or freedom from symptoms possible through surgical treatment.
- Prevention: No basic prevention possible, treat digestive disorders early, exercise and balanced diet
What is rectal prolapse?
In case of a rectal prolapse, the intestine prolapses again and again: The rectum completely protrudes towards the anus like a telescope. Since the rectum is also called the rectum or rectum, it is also referred to as rectal prolapse or rectal prolapse. In contrast to anal prolapse, here all tissue layers, i.e. also the muscle layers push through the anus, whereas in anal prolapse only the mucosa and the skin of the anal canal are affected. Rectal prolapse is sometimes up to ten centimeters long, while in anal prolapse a maximum of two centimeters protrude from the anus.
- Internal rectal prolapse: Here, the rectum does not (yet) protrude from the anus.
- External rectal prolapse: The rectum protrudes from the anus.
Typically, rectal prolapse recurs and sometimes regresses on its own or can be pushed back. In the beginning, especially internal rectal prolapse often goes unnoticed. Over time, however, the severity usually increases and the rectum protrudes from the anus because the sphincter (anal sphincter) is damaged or weakened.
What can be done about rectal prolapse?
Treatment of rectal prolapse depends on the degree of suffering of the affected person and the present severity. Since rectal prolapse is not life-threatening in most cases, the decision for therapy depends, among other things, on how much the quality of life is limited. If the sphincter muscle is damaged, resulting in fecal incontinence, doctors usually recommend surgical treatment.
Non-surgical treatment of rectal prolapse
Surgical treatment of rectal prolapse
In most cases, doctors perform surgery for rectal prolapse. The goal of surgery is to relieve discomfort and regain continence, the ability to control bowel movements and evacuation. There are over 100 different surgical procedures for this purpose. The most appropriate procedure depends on the individual patient’s condition. In terms of surgical methods, there are two types:
- Interventions via the anus
- @ Interventions via the abdominal cavity
The surgical methods via the anus have the advantage that the abdominal tissue is not injured and often gentler anesthesia procedures are used. Procedures via the abdominal cavity are usually performed via laparoscopy and, less commonly, via an abdominal incision (laparotomy). One advantage of the surgical method via the abdominal cavity is that it allows other organs, such as the uterus and vagina, to be elevated by the procedure. In many cases, rectal prolapse is accompanied by lowering of other organs in the lower abdomen.
What complaints does rectal prolapse cause?
Rectal prolapse often causes the following complaints at the beginning:
- Oozing
- Itching
- bleeding
- Stool smearing (drag marks in the underwear)
These symptoms are most common with internal rectal prolapse. Fecal incontinence, in which gas also passes uncontrollably, develops over time. Especially if the sphincter muscle takes damage.
That the complete rectum hangs out is rare. Pain is also a symptom that sufferers describe less often. In contrast, problems with defecation or the feeling of incomplete defecation are common. In addition, rectal prolapse primarily limits the quality of life of the affected person due to the discomfort.
How does rectal prolapse develop?
Rectal prolapse usually develops through the interaction of various factors. Genetic factors for a predisposition to tissue weakness as well as anatomical conditions play a role. The rectum, urinary bladder and uterus are attached to their place in the lower pelvis by certain physical structures. These structures consist primarily of ligaments and muscles of the pelvic floor. If this is weakened, it favors the development of rectal prolapse. A damaged sphincter also increases the risk of rectal prolapse.
In addition, pelvic operations such as gynecological surgery or chronic digestive disorders such as constipation and diarrhea are among the risk factors for rectal prolapse. In most cases, hemorrhoids coexist.
Rectal prolapse in children
This condition of prolapsed bowel occurs very rarely in children, and when it does, it is in children under the age of three. Risk factors for rectal prolapse at this age include malnutrition or chronic respiratory diseases such as cystic fibrosis.
How is rectal prolapse diagnosed?
The doctor usually diagnoses rectal prolapse by means of a physical examination. The distinction from anal prolapse is usually the first priority. For this purpose, the doctor palpates the prolapsed bowel, whereby the rectal mucosa is not very sensitive to pain. If it is an external rectal prolapse, he can often tell from the mucosa whether it is an anal or a rectal prolapse. Another clue is that in anal prolapse, a maximum of a few centimeters (one to two) protrude from the anus. If it is more, this speaks for a rectal prolapse.
In some cases, especially in the case of internal rectal prolapse, defecography using magnetic resonance imaging (MRI) is helpful. During a defecography, the affected person is given a contrast medium introduced into the rectum. During the examination, he or she tenses and relaxes the sphincter muscle and empties stool. This process is then recorded by MRI and provides information about the existing bowel disorder and its treatment options.
If constipation is present, the physician occasionally measures the so-called colon transit time. Here, the patient takes certain marker tablets, which are located in the intestine by means of an X-ray examination after about a week. Depending on where the markers from the tablets are located in the intestine, this allows the colon transit time to be calculated. This allows the physician to assess whether the colon is transporting food at a normal rate.
If gynecological or urological complaints also occur, such as urinary incontinence or vaginal prolapse, the doctor will also clarify this. In most cases, the patient is then referred to the appropriate specialist, such as a urologist or gynecologist.
What is the course of rectal prolapse?
Although this is not the rule, early treatment is still recommended. If surgery is necessary, it often improves the symptoms of rectal prolapse. The ability to control bowel movements independently is regained in a majority of those affected. After surgery, there are follow-up appointments where the doctor checks for evidence of inflammation or bleeding. In most cases, patients who have undergone surgery are also given stool-regulating medications for a few weeks after the procedure to prevent constipation.
For those affected, it is now advisable to pay attention to a balanced diet and to prevent possible constipation at an early stage. Exercise that strengthens the pelvic floor is also important. Some clinics or physiotherapists offer special courses to learn appropriate exercises to strengthen the pelvic floor muscles.
Can rectal prolapse be prevented?
Rectal prolapse is generally not preventable. Genetic predisposition and changes due to vaginal births are difficult to prevent. However, it is advisable to have chronic constipation or diarrhea clarified by a doctor and to pay attention to normal digestion. A balanced diet and sufficient exercise contribute to this.
