Rectal prolapse

Prolapse

Prolapse literally means "to fall out of place", from the Latin prolabi meaning "to fall out". In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is used for organs protruding through the vagina or the rectum or for the misalignment of the...

normally describes a medical condition wherein the walls of the rectum

Rectum

The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...

 protrude through the anus

Anus

The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...

 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
  Internal intussusception
  Internal intussusception of the rectum is a medical symptom associated with straining to defecate, usually associated with chronic constipation and diagnosed by defecography. Surgical interventions to correct the problem have exhibited limited success, usually treating the intussusception but not...
  
  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 may occur due to the following causes: 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 maneuvers (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 constipation) 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, which involves rectopexy in the sacral hollow or to the promontory with a synthetic material
  • Altemeier perineal rectosigmoidectomy
  • Hemorrhoid
    Hemorrhoid
    Hemorrhoids or haemorrhoids , are vascular structures in the anal canal which help with stool control. They become pathological or piles when swollen or inflamed. In their physiological state they act as a cushion composed of arterio-venous channels and connective tissue that aid the passage of...
    
    ectomy
• Children are treated with linear cauterization
• Manchester operation
  Manchester operation
  The Manchester operation or simply "Fothergill operation" is a technique used in gynecology operations. It is an operation for uterine prolapse...
  
  is used for combined pelvic prolapse.

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

External links

• Selected abstracts from recent medical literature on Rectal Prolapse