Rectal Prolapse: Symptoms, Causes & Treatment
Rectal prolapse is a medical condition characterized by the protrusion or displacement of the rectum through the anus. It occurs when the rectal walls weaken or lose their support, leading to the rectum slipping out of its normal position. This blog post aims to provide an overview of rectal prolapse, including its symptoms, causes, and treatment options. By understanding the key aspects of this condition, individuals can recognize the signs, seek appropriate medical attention, and make informed decisions about their healthcare.
Understanding Rectal Prolapse
Rectal prolapse is a medical condition in which the rectum, which is the lower part of the large intestine, protrudes or falls out of its normal position and extends through the anus. It can vary in severity, ranging from a partial prolapse where only the inner lining of the rectum protrudes, to a complete prolapse where the entire wall of the rectum protrudes outside the body.
To understand rectal, prolapse, it’s essential to have a basic knowledge of the anatomy involved. The rectum is located between the sigmoid colon and the anal canal. It serves as a temporary storage site for stool before it is eliminated from the body. The rectal walls consist of layers of muscles and connective tissues that help maintain the rectum’s position and support its function.
When these supporting structures weaken or become damaged, the rectum can start to protrude. This can be caused by factors such as chronic constipation, childbirth, aging, weakened pelvic floor muscles, previous rectal surgeries, or conditions that affect the connective tissues. The resulting rectal prolapse can cause discomfort, pain, and difficulty with bowel movements.
Understanding the anatomy involved in rectal prolapse provides a foundation for comprehending the causes, symptoms, and treatment options associated with this condition.
Types of Rectal Prolapse
Rectal prolapse can be classified into three main types based on the extent of prolapse and the involvement of the layers of the rectal wall. These types are:
- Internal Rectal Prolapse (Internal Intussusception): Also known as mucosal prolapse or rectal intussusception, this type involves the inner lining of the rectum (mucosa) slipping or telescoping into the rectal lumen. The prolapse may not protrude outside the anus, and the symptoms can be subtle or intermittent. It may be associated with chronic heartburn, constipation or abnormalities in the pelvic floor muscles.
- Partial Thickness Rectal Prolapse (Mucosal Prolapse): In this type, the inner lining of the rectum (mucosa) protrudes through the anus during bowel movements but retracts back spontaneously afterward. It can cause symptoms like bleeding, mucus discharge, and a sensation of incomplete evacuation.
- Full Thickness Rectal Prolapse (Complete Prolapse): This is the most severe form of rectal prolapse, where the entire wall of the rectum protrudes through the anus. It may occur during bowel movements or even with normal activities. The prolapsed rectum often requires manual reduction to return it to its normal position. Symptoms include a visible mass outside the anus, abdominal pain, discomfort, fecal incontinence, and difficulty with bowel movements.
Symptoms of Rectal Prolapse
Rectal prolapse can cause a range of symptoms that may vary in severity depending on the type and extent of the prolapse. The common symptoms of rectal prolapse include:
- Protrusion of Rectal Tissue: The most noticeable symptom is the protrusion of the rectal tissue through the anus. In partial or mucosal prolapse, the protrusion may occur during bowel movements and retract spontaneously afterward. In complete prolapse, the protrusion is usually more constant and may require manual reduction to return the rectum to its normal position.
- Discomfort or Pain: Rectal prolapse can cause discomfort or pain in the anal area. This can be a result of the prolapsed tissue rubbing against clothing, irritation, or pressure on the nerves in the area.
- Bowel Dysfunction: Individuals with rectal prolapse may experience changes in their bowel habits. This can include constipation, difficulty with bowel movements, or a feeling of incomplete evacuation. In some cases, there may be associated fecal incontinence or leakage of stool.
- Bleeding or Mucus Discharge: Rectal prolapse can lead to bleeding from the protruded rectal tissue. This can manifest as bright red blood on the surface of stools or on toilet tissue after wiping. Mucus discharge from the rectum may also occur.
- Sensation of a Lump or Mass: Some individuals may experience a sensation of a bulge, lump, or fullness in the rectal area, particularly during or after bowel movements.
- Vaginal or Pelvic Pressure: In women, rectal prolapse can cause sensations of vaginal pressure or a feeling of something coming out of the vagina.
Causes and Risk Factors of Rectal Prolapse
The exact cause of rectal prolapse is not always clear, but there are several factors that can contribute to its development. The causes and risk factors associated with rectal prolapse include:
- Weakened Pelvic Floor Muscles: Weakness or damage to the muscles and connective tissues that support the rectum and pelvic organs can increase the risk of rectal prolapse. This can be caused by factors such as childbirth, chronic constipation, aging, or previous pelvic surgeries.
- Chronic Constipation: Straining during bowel movements due to chronic constipation can put excessive pressure on the rectal walls. Over time, this can contribute to the development of rectal prolapse.
- Age: Rectal prolapse is more common in older adults, particularly in those over the age of 50. The weakening of muscles and tissues that naturally occurs with age can make the rectum more prone to prolapse.
- Genetic Factors: There may be a genetic predisposition to rectal prolapse, as it sometimes occurs in families. Certain genetic connective tissue disorders, such as Ehlers-Danlos syndrome, can also increase the risk of rectal prolapse.
- Chronic Coughing: Conditions that cause chronic coughing, such as chronic obstructive pulmonary disease (COPD) or whooping cough, can put strain on the pelvic floor and contribute to rectal prolapse.
- Previous Pelvic or Abdominal Surgeries: Prior surgeries in the pelvic or abdominal region, such as hysterectomy or bladder repair surgery, can weaken the supporting structures and increase the risk of rectal prolapse.
- Other Factors: Certain neurological conditions, such as multiple sclerosis, spinal cord injury, or stroke, can affect the nerves that control the muscles of the rectum and contribute to prolapse. Heavy lifting, obesity, and a sedentary lifestyle are additional factors that may increase the risk.
Diagnosis of Rectal Prolapse
Diagnosing rectal prolapse typically involves a combination of medical history assessment, physical examination, and potentially additional tests to confirm the diagnosis. Here are the main methods used for diagnosing rectal prolapse:
- Medical History and Symptoms: The healthcare provider will discuss your symptoms and medical history to gain insights into your condition. They may inquire about your bowel habits, the frequency and duration of rectal protrusion, associated discomfort or pain, and any factors that exacerbate or relieve your symptoms.
- Physical Examination: A thorough physical examination is performed to assess the extent and characteristics of the rectal prolapse. The healthcare provider may visually inspect the anus and rectum while you strain or bear down as if having a bowel movement. They may also manually examine the rectum by inserting a lubricated gloved finger to evaluate the rectal tone, presence of masses, or any other abnormalities.
- Additional Tests: In some cases, additional tests may be required to confirm the diagnosis or evaluate the underlying causes of rectal prolapse. These tests may include:
- Anorectal Manometry: This test measures the pressure and function of the rectal and anal muscles to assess their coordination and strength.
- Defecography: Defecography is an imaging test that uses X-rays or fluoroscopy to evaluate the mechanics of bowel movements. It can help identify abnormalities in the rectum, pelvic floor muscles, and anal sphincter.
- Colonoscopy or Flexible Sigmoidoscopy: These procedures involve inserting a flexible tube with a camera into the rectum to examine the rectal and colonic lining for any abnormalities or contributing factors.
- Imaging Studies: In some cases, imaging studies such as magnetic resonance imaging (MRI) or computed tomography (CT) scans may be used to obtain detailed images of the rectum and surrounding structures.
Treatment Options of Rectal Prolapse
The treatment options for rectal prolapse depend on the severity of the prolapse, the individual’s overall health, and their preferences. The main treatment approaches for rectal prolapse include:
- Manual Reduction: In cases of partial or occasional rectal prolapse, the prolapse may be manually pushed back into place by the individual or a healthcare professional.
- Diet and Lifestyle Modifications: Making dietary changes to ensure regular bowel movements and avoiding constipation can help reduce strain on the rectum. Increasing fiber intake, staying hydrated, and establishing a consistent bowel routine can be beneficial.
- Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises such as Kegels may improve muscle tone and support the rectum.
- Medications: In some cases, medications may be prescribed to address underlying factors contributing to rectal prolapse, such as constipation or diarrhea.
- Rectopexy: This surgical procedure involves securing the rectum to the surrounding tissues or the sacrum (the triangular bone at the base of the spine) to restore its proper position and prevent prolapse.
- Resection Procedures: In cases where the rectum is extensively prolapsed or damaged, a resection may be necessary. Procedures like anterior resection or rectosigmoidectomy involve removing a portion of the rectum and reattaching it to the remaining rectum or colon.
- Perineal Procedures: Perineal approaches, such as Delorme’s procedure or Altemeier’s procedure, are performed through the perineum (the area between the anus and the genitals) to remove excess rectal tissue and repair the prolapse.
- Colostomy: In rare cases of severe or recurrent rectal prolapse that cannot be effectively treated by other means, a colostomy may be considered. This involves creating an opening (stoma) in the abdominal wall through which stool is passed into an external bag.
In conclusion, rectal prolapse is a condition that can significantly impact an individual’s quality of life. Understanding its symptoms, causes, and available treatment options is crucial for timely diagnosis and appropriate management. Dr. Vatsal Mehta, a renowned expert in colorectal disorders, has been at the forefront of providing comprehensive care and guidance to patients with rectal prolapse. Dr. Mehta emphasizes the importance of personalized treatment plans tailored to each individual’s unique needs. By seeking the expertise of professionals like Dr. Vatsal Mehta, individuals can find effective solutions and regain control over their health, improving their overall well-being and quality of life.