Rectal prolapse

Rectal prolapse
Specialty	Gastroenterology

Rectal prolapse normally describes a medical condition wherein the walls of the rectum protrude through the anus and hence become visible outside the body.

Types

There are three chief conditions which come under the title rectal prolapse:

• Full-Thickness rectal prolapse describes the entire rectum protruding through the anus
• Mucosal prolapse describes only the rectal mucosa (not the entire wall) prolapsing
• Internal intussusception wherein the rectum collapses but does not exit the anus

Causes

Rectal prolapse is caused by the weakening of the ligaments and muscles that hold the rectum in place. In most people, the anal sphincter is weak. Rectal prolapse is often associated with the following conditions: advanced age, long term constipation, long term straining during defecation, receiving anal sex, long term diarrhea, high gastrointestinal helminth loads, pregnancy and stresses of childbirth, previous surgery, cystic fibrosis, COPD, and sphincter paralysis.

Progression

The condition of Rectal prolapse, a type of rectal rupture, undergoes progression: beginning with prolapsation during bowel movements, through Valsalva movements (sneezing and so forth), then through daily activities such as walking until finally it may become chronic and ceases to retract.

Treatment

Partial prolapse may be treated by a diet high in fiber.

Pharmaceutically, the condition may only be treated secondarily (by treating deficate) so as to avoid further straining.

The alternative is surgery. It may be divided into two forms of procedure: abdominal surgery and perineal surgery.

• Abdominal surgery - for younger patients, but is more dangerous
  • Anterior resection
  • Marlex rectopexy
  • Suture rectopexy
  • Resection rectopexy
• Perineal surgery - often performed on older patients and is less dangerous
  • Anal encirclement
  • Delorme mucosal sleeve resection
  • Altemeier perineal rectosigmoidectomy
  • Hemorrhoidectomy
• Children are treated with linear cauterization

Recently, robotic-assisted surgery has been introduced as a treatment option.

Notes

Because most sufferers are elderly, the condition is generally under-reported.

The condition can also occur in children.

External links

• Selected abstracts from recent medical literature on Rectal Prolapse