What is rectal prolapse?
Rectal prolapse is a condition in which the rectum loses its internal support and protrudes or falls out of the anus. In the earliest phase, the rectal prolapse may be internal, but as the condition progresses, the rectum can be seen or felt outside of the body. When this occurs, it is called a complete rectal prolapse. Weakness of the anal sphincter muscle often is an associated problem at this stage and may result in leakage of stool or mucus at unwanted times. The condition occurs in both sexes, but is more common in women than in men.
Why does it occur?
Rectal prolapse seems to be part of the aging process, due in part to weakening of supporting structures within the pelvis as well as loss of anal sphincter muscle tone. Several things may contribute to the development of rectal prolapse. A lifelong habit of straining to have bowel movements may contribute, or it may occur as a late result of the stresses involved in childbirth. There may be a hereditary factor in some families. In most cases, however, there is no single cause which can be identified; it just happens.
Is Rectal Prolapse the same as Hemorrhoids?
No. Rectal Prolapse involves a part of the rectum which is higher than the level of hemorrhoids. Some of the symptoms, however, may be the same. There may be bleeding and/or tissue which protrudes from the rectum in both conditions, and neither condition typically is associated with pain.
How is Rectal Prolapse diagnosed?
Usually by taking a careful history and performing a complete anorectal examination, the physician can readily diagnose this condition. By asking the patient to strain, as if they are having a bowel movement , or by having the patient sit on the commode and strain prior to examination, the prolapse can be identified. At times the prolapse may be hidden or internal. An x-ray examination called a videodefecogram may be helpful for diagnosis. This examination takes pictures during a simulated bowel movement and may help to determine the appropriate type of surgery. Anorectal manometry also may be helpful. This test measures muscle function, and also can diagnose nerve disorders which may affect the sphincter muscles.
How is Rectal Prolapse treated?
Although constipation and straining may be possible causes of rectal prolapse, correction of these may not improve the actual prolapse after it has developed. There are several different surgical methods used to correct rectal prolapse. Your doctor can help you decide which method likely will give the best result depending on your individual situation.
Implanting a band of elastic material
The simplest method involves implanting a band of elastic material under the skin around the outside of the anal muscle. This is called the Thiersch procedure. This keeps the anus from stretching to allow the rectum to fall out. This procedure does require the use of an operating room and an anesthetic, but usually can be done without requiring an overnight stay in the hospital. Unfortunately, in nearly half of the cases, the elastic material is rejected by the body, necessitating its removal. Despite this, there may be enough scar tissue formed to improve control of the anus and to delay the return of the prolapse for months or years after removal of the elastic material.
Removing the extra tissue from the rectum (Delorme procedure / Altemeier procedure)
Another approach involves operating through the anus and removing the extra tissue from the rectum. This approach is called the Delorme procedure or the Altemeier procedure. These operations usually require a brief hospital stay, but since no skin incisions are needed, there is usually little pain afterward, and patients rapidly return to their full activity. Rectal prolapse may recur in 1 of 10 patients after a variable period of time, but the correction is permanent in 9 of 10.
Correcting the rectal prolapse from inside
The most complicated approach involves operating through the abdomen and correcting the rectal prolapse from inside. This approach often involves removing a segment of the colon or rectum which is too long, as well as re-supporting the rectum from inside. This procedure involves a few days' stay in the hospital after surgery, but it is the most permanent and effective operation for advanced cases.
How successful is the Treatment?
Success depends on a number of factors, including the status of the anal sphincter muscles before surgery, whether the prolapse is internal or external, the overall condition of the patient and the surgical method used. If the anal muscle has been weakened due to the prolapse, this will often, but not always, improve after correction of the rectal prolapse. In situations where the anal sphincter muscle remains weak and there remains incontinence or seepage, the Thiersch procedure is sometimes helpful at a later time. The great majority of patients, however, are completely and permanently relieved of symptoms or are significantly improved by the appropriate procedure.