Rectal Prolapse - Types, Causes, Risk Factors, Symptoms, Diagnosis, Treatment, and Prevention

Introduction:

The rectum is the last part of the large intestine, and the anus is the opening through which stool exits the body. Rectal prolapse is when the rectum slips from its normal position from the anus. However, it is not a medical emergency but causes mild discomfort. Therefore, rectal prolapse is relatively uncommon.

What Are the Types of Rectal Prolapse?

There are three types of rectal prolapse:

• Complete Prolapse: The entire rectum slips out of the anus.

• Partial Prolapse: Part of the rectal lining slips out of the anus. This is also called mucosal prolapse.

• Internal Prolapse: The rectum has prolapsed, but it has not yet pushed through the anus.

What Are the Causes of Rectal Prolapse?

The exact cause of rectal prolapse is not clear. However, possible causes of rectal prolapse include:

• The weakening of muscles and ligaments in the rectum is related to old age.

• Chronic constipation or straining.

• Previous injury to the lower back or pelvis.

• Loose anal sphincter muscle.

• Neurological problems such as spinal cord disease.

• Parasitic infection of the intestine.

• Conditions that weaken the muscle supporting the rectum, like pregnancy, vaginal childbirth complications, and anal sphincter paralysis.

• A congenital disease of the bowel, such as Hirschsprung’s disease.

What Are the Risk Factors of Rectal Prolapse?

The following conditions also increase the risk of rectal prolapse including.

• Women older than 50 are at high risk.

• Chronic constipation.

• Long-term diarrhea.

• Cystic fibrosis.

• Spinal cord problems.

• Straining to poop.

• Muscle weakness in the anus or pelvic floor.

• Aging or dementia.

• Family history of rectal prolapse.

What Are the Symptoms of Rectal Prolapse?

Rectal prolapse is common in children and older adults, especially women. Symptoms differ from person to person, including:

• Feeling a bulge outside the anus after coughing, sneezing, or lifting.

• Pain in the anus or rectum.

• Straining to have a bowel movement.

• Abdominal discomfort or pain.

• Fecal incontinence.

• Bleeding from the rectum.

• Feeling pressure in the rectum.

• Constipation or diarrhea.

• Seeing a red mass outside the anus opening.

• Leak of blood, poop, or mucus from the anus.

How Can We Diagnose Rectal Prolapse?

• Physical Exam: The patient is asked to mimic a bowel movement to see the prolapse. The doctor examines if there is a complete or partial prolapse. The doctor may also do a digital rectal exam using a lubricated, gloved finger into the rectum and confirm the diagnosis.

Additional tests to diagnose rectal prolapse include:

• Defecography: This test shows how well the rectum can hold the stool. This test uses X-rays or Magnetic Resonance Imaging (MRI).

• Colonoscopy: A long, thin tube attached to a tiny camera is inserted into the rectum. This helps in viewing the rectum and the entire colon. This test is used to find out the cause of prolapse.

• Lower Gastrointestinal Series: This test uses X-rays and a chalky barium liquid to view the large intestine.

• Anal Manometry: A thin, flexible tube is inserted into the rectum to test how well the muscles and nerves present in the rectum and anus are working.

• Magnetic Resonance Imaging (MRI): This test evaluates the organs used during bowel movements.

What Is the Treatment of Rectal Prolapse?

Treatment depends on the age, physical health, and severity of the condition. Treatment is first focused on preventing constipation and straining. If the rectal prolapse is minor, the doctor prescribes stool softeners, suppositories, or other medications.

In case of extreme anal prolapse, the common treatment is surgery which puts the rectum back in its normal position. The two most common types of surgery include to correct extreme anal prolapse are:

• Abdominal Repair: This type of surgery is done with a cut in the lower abdomen. It may be done as a large cut or through laparoscopy, in which small cuts are made through which instruments can be inserted. The rectum is present at the lower portion of the backbone to support and keep it in place.

• Rectal Repair: This type is preferred in older people or those with medical problems. During this procedure, the surgeon eliminates the part of the rectum extending out of the anus, and the two ends are stitched back together.

Sometimes, a repair can be done by combining both methods. Even after the surgery, rectal prolapse can recur again. Lifestyle alterations can prevent from recurring again. Abdominal surgery has a lower chance of recurring back than rectal surgery.

Rectal prolapse cannot heal itself. This condition needs to be managed through surgery.

What to Expect Immediately After Surgery?

• The staff in the hospital will check for pulse, breathing, temperature, etc.

• The fluid in the body will be replaced through an intravenous fluid line placed in the arm.

• The person will be given pain-relieving medication.

• A catheter will be placed which will help to drain the urine.

• The vaginal pack if present, will be taken off the same day or the next day of the surgery.

• The person will be asked to stay in the hospital for three to six days post-surgery.

How Can We Prevent Rectal Prolapse?

Rectal prolapse self-care can be done by not straining during bowel movements. Rectal prolapse self-care can be done by following the steps below to prevent constipation or straining during poop:

• Eat a high-fiber diet. Eat more fruits and vegetables.

• Drink about six to eight glasses of water a day.

• Stay active and do regular exercise.

• Maintain a healthy weight.

• Avoid heavy lifting.

• If constipation is present, consult a doctor. He might prescribe a stool softener or a laxative.

What Are the Complications of Rectal Prolapse?

If untreated, rectal prolapse can lead to the following complications:

• Rectal damage like ulceration or bleeding.

• Damage to the sphincter muscles and nerves.

• A rectal prolapse that cannot be pushed back into the rectum can cause a reduction of blood supply in the rectum (strangulation).

• Urinary retention.

• Recurrence of rectal prolapse.

• Worsening of constipation.

How to Differentiate between Hemorrhoids and Rectal Prolapse?

Hemorrhoids and rectal prolapse can cause similar symptoms in the rectum. Hemorrhoids are swollen blood vessels that are seen in the rectum and anus, whereas rectal prolapse is the bulging of the rectum out of the anus. Hemorrhoids can cause bloody stools, itching, discomfort, and pain in the anus. Rectal prolapse affects only the rectum, whereas hemorrhoids affect the rectum and anus. Early rectal prolapse can look like hemorrhoids, making it difficult to differentiate.

Conclusion:

Rectal prolapse is a condition where the rectum can itself turn inside out. Rectal prolapse is a chronic disturbing condition. In the early stages, the bulging rectum can return on its own, but it mostly requires surgical intervention in severe cases. The pain and discomfort caused by this condition depends upon the severity of the condition.