Rectal prolapse

Rectal Prolapse

Rectal prolapse is a condition in which the rectum (the last part of the large intestine) slips out through the anus. 
It can range from mild internal prolapse to complete protrusion outside the body and often worsens over time if untreated.

Types and Grading of Rectal Prolapse

Internal Rectal Prolapse (Intussusception)

1. The rectum folds into itself but does not come out of the anus.
2. Often associated with chronic constipation, incomplete evacuation, or obstructed defecation.

Partial (Mucosal) Rectal Prolapse

1. Only the inner lining (mucosa) of the rectum protrudes through the anus.
2. Usually seen during straining and may reduce on its own.

Complete (Full-Thickness) Rectal Prolapse

1. The entire wall of the rectum protrudes outside the anus.
2. May initially reduce spontaneously but later requires manual reduction or remains outside permanently.

Causes

1. Chronic constipation with repeated straining during bowel movements
2. Weakening of pelvic floor muscles due to aging or childbirth
3. Previous pelvic or anorectal surgeries
4. Chronic diarrhea causing frequent bowel strain
5. Neurological conditions affecting bowel control
6. Poor connective tissue support
7. Increased intra-abdominal pressure from chronic cough or heavy lifting
8. Malnutrition or significant weight loss
9. Congenital weakness of pelvic support structures

Symptoms

• Bulge or mass protruding from the anus
• Feeling of incomplete bowel evacuation
• Difficulty controlling bowel movements
• Mucus discharge or bleeding
• Pain or discomfort while sitting or walking
• Need to manually push the rectum back in
• Worsening symptoms during straining

When to Seek Medical Help

• Visible tissue coming out of the anus
• Difficulty pushing the prolapse back inside
• Bleeding, pain, or discharge from the prolapsed tissue
• Loss of bowel control
• Worsening constipation or difficulty passing stools
• Sudden increase in size or irreducibility of the prolapse

Early evaluation helps prevent complications like ulceration, infection, or strangulation of the prolapsed rectum.

Diagnosis

• Clinical examination during straining
• Proctoscopy or colonoscopy to rule out other conditions
• MRI pelvis for complex or recurrent prolapse
• Assessment of pelvic floor function when needed

Treatment Options

Conservative Management

1. Recommended for early or mild internal prolapse
2. Includes dietary fiber, stool softeners, adequate hydration
3. Pelvic floor exercises and bowel habit correction
4. Usually supportive, not curative for full prolapse

Surgical Treatment

1. Surgery is the definitive treatment for complete or symptomatic rectal prolapse
2. The choice depends on age, general health, and severity

Common Surgical Procedures

Abdominal Rectopexy

1. Rectum is re-positioned and fixed to the sacrum
2. Can be done by open or laparoscopic approach
3. Preferred in younger and medically fit patients
4. Lower recurrence rates

Laparoscopic Rectopexy

1. Minimally invasive approach with faster recovery
2. Less pain and shorter hospital stay

Perineal Procedures (Delorme or Altemeier Procedure)

1. Performed through the anus
2. Suitable for elderly or high-risk patients
3. Shorter surgery time but higher recurrence compared to abdominal methods

Aftercare and Recovery

1. Hospital stay usually ranges from 2 to 3 days depending on procedure
2. Pain is generally mild to moderate and well controlled with medication
3. Stool softeners are advised to avoid straining
4. High-fiber diet and adequate fluids are encouraged
5. Wound care instructions are provided if perineal surgery is done

Return to Normal Activities

• Light daily activities like driving can be resumed within 1 to 2 weeks
• Office work or sedentary jobs can be resumed in 1 to 2 weeks
• Heavy lifting and strenuous activity should be avoided for at least 4 to 6 weeks
• Complete recovery and pelvic floor stabilization may take 6 to 8 weeks

Regular follow-up helps monitor healing and prevent recurrence.