Rectal prolapse, or rectal prolapse, occurs when part of the colon from the lowest section (rectum) slips out of the muscular opening at the end of the digestive tract (anus). Surgery is usually required to treat rectal prolapse.
What is rectal prolapse?
Rectal prolapse is a rare condition and affects mostly older people. The condition is rare in children; affected children are usually younger than 3 years. Men are much less likely to develop rectal prolapse than women (80-90% chance). The disease affects the rectum, i.e. the last 12-15 centimeters of the colon just above the anal canal. Normally, the rectum is securely attached to the pelvis by ligaments and muscles. Various factors, such as age, long-term constipation or strain during childbirth, can weaken these. This causes the rectum to prolapse, i.e., to fall out of its natural body opening (rectal prolapse). A rectal prolapse must be distinguished from a rectocele, which refers to an outpouching of the rectum into the vaginal walls. Another form of rectal prolapse is called intussusception. In this case, one section of the bowel bulges into another, which can cause bowel obstruction.
Causes
Rectal prolapse is caused by weakening of the muscles that hold the rectum in place. In most people with rectal prolapse, the anal sphincter is also weak. The exact cause of this weakening is unknown, but risk factors for rectal prolapse usually include advanced age, prolonged constipation or persistent diarrhea, straining during bowel movements, pregnancy, and straining during childbirth. Causes of rectal prolapse may also include prior surgery, cystic fibrosis, or chronic disease. These include lung disease, whooping cough, multiple sclerosis, and long-standing hemorrhoidal conditions. Children with rectal prolapse should also be evaluated for cystic fibrosis, as it may be a symptom of this disease.
Symptoms, complaints, and signs
Rectal prolapse is manifested by several symptoms, although mild and incomplete prolapse can be quickly confused with hemorrhoidal disease. The main symptom of rectal prolapse in this case is the rectum that has reached the outside and is turned inside out. A distinction is made between a purely outwardly protruding rectum and the presence of an intussusception. The latter means an invagination into itself, whereas an invagination of the intestine into itself can also lead to a prolapse. As the mucous membranes of the bowel leak outward, sufferers experience a permanent feeling of dampness. At times, bleeding occurs because the leaking rectum is injured by clothing or manual manipulation. A foreign body sensation at the anus is often described by sufferers. Itching often develops, which can sometimes be explained by developing inflammation. A prolapse of the rectum almost always leads to incontinence symptoms. Thus, uncontrolled discharge of feces or mucus may occur. Incontinence is more pronounced the more severe the prolapse is. A complete rectal prolapse almost always means fecal incontinence. On the other hand, a prolapse that is only partial does not necessarily mean fecal incontinence, but it does very much result in the discharge of mucus. Rectal prolapse is also very clearly recognizable visually.
Diagnosis and course
In the early stages of rectal prolapse, the rectum gradually detaches but remains in the body. This stage of rectal prolapse, when the connective tissue of the rectal mucosa becomes detached and protrudes from the anus, is called mucosal prolapse. The more the rectum prolapses, the more a portion of the rectum presses on and weakens the anus. This stage is called complete rectal prolapse and is the most common diagnostic stage of the disease. Symptoms of rectal prolapse are similar to those of hemorrhoids and range from pain during bowel movements, mucus or blood from the protruding tissue, to fecal incontinence or loss of the urge to defecate. To diagnose an earlier stage in which the rectrum is not yet protruding from the anus, the physician may administer a phosphate enema to differentiate rectal prolapse from protruding hemorrhoids.Using a dynamic MRI, the entire pelvis, including the pelvic floor muscles and pelvic organs, can be scanned during bowel movements.
Complications
Rectal prolapse or rectal prolapse almost always requires surgery to avoid complications. Surgery is usually not necessary only in children. However, older individuals usually suffer from rectal prolapse. Due to the progressively increasing weakness of the connective tissue, self-healing no longer takes place here. When rectal prolapse occurs in children, there is usually another serious disease behind it, which also promotes the development of complications. Affected children should be examined for cystic fibrosis, among other things. In the much more common cases of rectal prolapse in older people, complications always develop over time if the condition is left untreated. However, life-threatening complications are the exception. As a rule, the rectum is not blocked because the bowel can always be pushed back. However, this can happen in exceptional cases. In this case, it is a life-threatening emergency that requires immediate surgical intervention to prevent the death of the corresponding section of the rectum. In other cases, although there is no emergency, surgical intervention is still necessary, because untreated rectal prolapse leads in the long term not only to increasing pain during defecation and blood and mucus on the stool, but also to fecal incontinence. The later the treatment, the more serious the associated complications. In addition, ulcers may develop in the rectal area.
When should you go to the doctor?
An experienced doctor can recognize rectal prolapse at a glance. Rectal prolapse, also known as dilated anal prolapse, is often found in older women. It definitely requires a visit to the doctor because parts of the intestine have leaked through the anal opening. The preliminary stages of this phenomenon were usually ignored and caused by pressing too hard on the toilet. They may not be noticed, as often only some folds of the rectum are protruded. Therefore, if the symptoms are minor, the visit to the doctor is often omitted. However, rectal prolapse can by no means go unnoticed as advanced anal prolapse. Rectal prolapse can occur as a result of heavy lifting or a coughing fit. If left untreated, rectal prolapse will persist indefinitely. It requires surgical treatment. In rectal prolapse, larger portions of the rectum have already escaped due to a weak pelvic floor or as a result of disease. As a result, the stool can no longer be held in the bowel. This leads to intestinal incontinence. Even before rectal prolapse occurs, a visit to the doctor should be considered. Treatment options are greater the earlier treatment is started. If there is a recurring sensation that the anus has prolapsed somewhat after defecation, a visit to the doctor should not be postponed any longer. For prophylaxis, women over 40 should start pelvic floor exercises.
Treatment and therapy
Nearly all cases of rectal prolapse require medical care. Occasionally, successful treatment of the underlying cause of rectal prolapse resolves the problem; most often, rectal prolapse will worsen without surgery. In infants and young children, reducing or thinning bowel movements under a doctor’s guidance may provide relief. Medical treatment is used to temporarily relieve the symptoms of rectal prolapse or to prepare the person for surgery. Fillers (bran, psyllium, methylcellulose or psyllium), stool softeners or enemas are used for this purpose. The goal of all surgical techniques to correct rectal prolapse is to reattach the rectum to the internal pelvis. This procedure, performed under general anesthesia, tends to be done through the abdominal wall in healthy and younger patients and through the perineum in older individuals or compromised health, generally requiring a hospital stay of three to seven days.
Prevention
Eating a high-fiber diet and staying hydrated daily can reduce the risk of developing constipation, a risk factor for rectal prolapse. Biofeedback therapies exercise the pelvic floor muscles and strengthen the sphincter.People with persistent diarrhea, constipation or hemorrhoids should treat them in time to eliminate the risk of rectal prolapse.
Follow-up
Rectal prolapse (rectal prolapse) requires consistent follow-up care, whether it has been treated conservatively or surgically. Essentially, it is important to prevent the condition from recurring or worsening. The gastroenterologist and proctologist, as well as the family doctor, are the professional contacts for this. In addition, there are self-help groups for people with proctological diseases, which can offer empathetic exchange of experiences and helpful tips. In the aftercare of rectal prolapse or rectal prolapse, stool regulation in particular is very important. Pressure during bowel movements should be prevented in any case. A (not too) soft and voluminous stool is ideal to avoid straining. Fruits and vegetables, especially fiber in the diet are suitable here. It is essential to ensure adequate drinking (usually about 1.5 to 2 liters of water or herbal tea). If this diet should not be sufficient for stool regulation, natural helpers can be used with psyllium husks. Stuffing foods such as chocolate or eggs should rather be avoided for a while. Exercise is also important for stool regulation. Light endurance sports and walking are recommended in this context. Gymnastics and yoga can also activate bowel movements. Prolonged sitting on the toilet should be avoided as well as too active pressing.
What you can do yourself
Rectal prolapse or rectal prolapse is a condition whose diagnosis and treatment belong in professional hands. Nevertheless, self-help by patients in everyday life is possible and also desirable. The active cooperation of the patient can prevent rectal prolapse and support both therapy and aftercare in a goal-oriented manner. In many cases, rectal prolapse is caused by strong pressing during bowel movements and a weakness of the connective tissue in the area of the pelvic floor. This is where self-help can be targeted. Constipation must be avoided at all costs, so that stool regulation plays an important role in the patient’s daily routine. This is achieved by a high-fiber diet in conjunction with sufficient drinking. Constipating food should be eliminated from the diet as much as possible. Plenty of exercise is also important, as physical activity can stimulate the bowel activity of those affected and thus have a favorable effect on rectal prolapse. Massages of the abdominal area and warm baths for constipation are also recommended, as are psyllium preparations. The pelvic floor can be well trained by suitable exercises. The exercises are taught by the physiotherapist or the attending physician and can be performed daily at home. Regular check-ups with the doctor are also important once a rectal prolapse has been identified and treated. Shame is a major obstacle here to discovering a prolapse (even a recurrence) as soon as possible and having it treated promptly and effectively.
