Rectal Prolapse

Rectal prolapse not the same as hemorrhoids. Some cases of hemorrhoids can worsen to appear as rectal prolapse where the rectal mucosa lining protrudes from the anal opening. This condition is considered uncommon and instances are often recorded among the elderly population starting in the 50s with preponderance to the female gender.

Presentation

Patients suffering from rectal prolapse complain about a palpable tissue mass protruding from their anus.

In some cases, the mucosa protrusion is temporary resulting from a difficult bowel movements. It usually retracts spontaneously back into the inner sanctum of the rectal canal without any treatment but can become permanent with age and repeated passing of hard stools.

As the conditions progresses, the rectal colon loses its spontaneous retraction and patients find themselves manually pushing it back inside.

After a while, the prolapse becomes bigger and reappears right after being pushed inwards. It then becomes problematic as pain and discomfort starts to occur when sitting or walking. Full thickness rectal prolapse include the entire inner lining of the rectal canal protruding while mucosal rectal prolapse only has the mucosal layer protruding.

Sufferers also report incontinence as the anus becomes dilated and the rectal mucosa lining exposed, disrupting the sphincter function. Additionally, because the rectal mucosa is exposed to the air, it constantly discharges mucous that can give the patient a disturbing feeling of being wet in the anal area and a false impression of incontinence.

Common Causes Of Rectal Prolapse

• The condition is often caused by repeated constipation that predisposes the sufferer to chronic straining of the rectal muscles during defecation.

• Pregnancy, which can stress abdominal muscles as well as neurological disorders are often contributing factors to getting rectal prolapse.

• Genetic predisposition is likewise considered as a weak and loose mucosa lining in the rectal canal can easily dislodge from the underlying muscle and protrude outside.

• Anatomic features like a patulous anal sphincter, poor posterior rectal position, among other, have been observed to be common among rectal prolapse patients.

Diagnosis And Treatment

Patients are clinically diagnosed by letting them sit on a toilet bowl and strain themselves to simulate a bowel movement to confirm that the rectum prolapses.

The administration of phosphate enema or glycerin suppository in kids can be used to induce a prolapse. The protruding tissue mass should reveal concentric rings of mucosa which are definitive signs of rectal prolapse. The patient’s detailed history of constipation and/or incontinence is important in determining the proper surgical procedure to correct rectal prolapse.

Rectal prolapse is an indication for surgical correction in most cases and depending on the condition of the prolapse whether it’s a full thickness or a mucosal one, different surgical techniques are used.

Surgical methods employed by colon and rectal surgeons include Sigmoid Resection and Rectopexy as well as Perineal Proctectomy (Altemeier Procedure).

Early rectal prolapse can be treated with topical ointments to constrict blood flow and dry-up the protruding mass so it can eventually fall off. Alternatively, stool softening diet rich in fiber and laxatives can relieve constipated bowel movements to lessen any existing predisposition to rectal prolapse. But with stronger medication and new non-surgical out-patient procedures, mild to moderate cases of rectal prolapse can be treated with ligation.

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