Rectal prolapse - causes, symptoms and treatment

Rectal prolapse (rectal prolapse, pelvic floor prolapse)

Rectal prolapse is a condition when the rectum or part of it loses its proper position inside the body, becomes mobile, stretches and comes out through the anus.
Rectal prolapse is divided into two types: internal (hidden) and external. Internal rectal prolapse differs from external rectal prolapse in that the rectum has already lost its position, but has not yet come out. Rectal prolapse is often accompanied by weakening of the anal canal muscles, which leads to incontinence of gas, feces and mucus. The problem of rectal prolapse occurs quite often in our patients. This condition is also known as rectal prolapse or pelvic floor prolapse and is more common among women than men.

In women, the main factors for the development of rectal prolapse are pregnancy and childbirth. The prerequisites for the appearance of the disease in men may be regular physical activity or the habit of strong straining.

Rectal prolapse usually does not cause pain at the very beginning of the disease. The main problems with rectal prolapse for patients are a feeling of discomfort and a foreign body in the anus, as well as an unaesthetic appearance, which significantly worsens a person’s quality of life.

Rectal prolapse usually responds well to treatment and has a low recurrence rate (recurrence of the disease)—only about 15%. Complications in treatment usually arise when the patient seeks specialized help late and attempts to self-diagnose and treat. The result of these actions is lost time for success in treatment. If no treatment is taken, part of the prolapsed intestine will gradually increase, in addition, the anal sphincter will stretch, and the likelihood of damage to the pelvic nerves will also increase. All this entails the following complications:

Ulcers of the rectal mucosa.
Tissue death (necrosis) of the rectal wall.
Bleeding.
Incontinence of gas, mucus and feces.

The length of time over which these changes occur varies widely and differs from person to person; no doctor will give an exact time frame for how long these serious problems can occur.

Normal condition

With loss

About small intestinal hernias

A small bowel hernia, also called small bowel prolapse, occurs when the small bowel moves downwards and puts pressure on the upper part of the vagina. This results in a protrusion (see Figure 1).

Figure 1. Internal organs of a woman with and without a small intestinal hernia

A small intestinal hernia occurs when the upper part of the vagina weakens. This may be caused by:

aging;
vaginal birth of large children;
menopause;
hysterectomy (surgery to remove the uterus) or other gynecological surgery.

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Rectal prolapse and hemorrhoids

One of the common reasons why a patient does not see a doctor immediately after a problem arises is the external similarity of the manifestation of the disease with hemorrhoids, which they try to cure on their own - with suppositories and ointments. In fact, rectal prolapse and hemorrhoids are completely different diseases, which may actually appear similar in appearance due to the influx of tissue from the anal canal. Only with hemorrhoids does the hemorrhoidal tissue fall out, and with rectal prolapse does part of the rectum fall out. Also, both diseases have some similar symptoms, such as bleeding.

It is important to remember that incorrect diagnosis and incorrect treatment will never lead to the expected positive effect, and in some cases will worsen the problem.

Symptoms of an abdominal hernia

The first signs of a hernia are pain that occurs when walking, coughing, working, and various physical efforts. The pain is worse in the initial period; As the size of the pathology increases, the pain decreases.

At the same time, a protrusion appears, which can be reduced into the abdominal cavity or it is reduced spontaneously.

When colon loops exit into the hernial sac, signs of chronic intestinal obstruction are observed: abdominal pain, belching, vomiting, nausea, constipation. Displacement of the bladder into the hernial sac causes urination disorders. If infringement of the pathology occurs, this manifests itself in the appearance of severe pain in the area of the hernial protrusion, which ceases to be reduced into the abdominal cavity and acquires a rocky density when palpated. With pathology of the esophageal opening of the diaphragm, no external signs may be observed. However, sometimes stomach contents may back up into the esophagus, leading to heartburn, indigestion, chest pain, hiccups and belching. If you find any of the above mentioned signs, consult a doctor as soon as possible.

Causes of the disease

What causes rectal prolapse?

Anything that increases pressure inside the abdomen can cause rectal prolapse to develop. Constipation, diarrhea, prostatic hyperplasia (straining when urinating), pregnancy and childbirth, persistent cough.
Damage to the anus, pelvic floor muscles, back nerves, pelvic nerves during previous surgery or injury.
Intestinal infections with certain types of germs called parasites (such as amoebiasis and schistosomiasis).
Some diseases of the nervous system, such as multiple sclerosis.
Mental health conditions associated with constipation such as: depression, anxiety, side effect of medications used to treat mental disorders.

Preventive measures

Problems with stool in women can be prevented using prevention methods. Bulk laxatives can serve as a preventive measure - we remember that they can be taken for a long time. This is especially true for cases when, for various reasons, you have to limit yourself in consuming foods rich in fiber.

Other preventive measures include the following:

morning exercises, a general increase in daily physical activity - walking, hiking, swimming, light fitness, yoga, stretching, dancing, etc.;
formation of daily morning rituals - it is important, if possible, to adhere to the daily routine, get up with plenty of time to be able to go to the toilet without haste;
correction of concomitant conditions, consulting a doctor about PMS, treatment of diseases of the pelvic organs, etc.

In some cases, it may be relevant to take probiotics and prebiotics to normalize the intestinal microflora, work with stress resistance and other methods aimed at eliminating the main causes of frequent constipation in a woman.

Symptoms of rectal prolapse

The most common symptom that should alert you is the sensation of a foreign body in the anus coming out of the anus. In the early stages, this may happen when straining, but as the condition progresses, it can happen when coughing, sneezing, standing up, or walking. In the early stages, when the prolapse is relatively minor, manual assistance (using the fingers to move the intestines inward) will be successful, but over time this will also become impossible.
The feeling of incomplete bowel movement usually occurs in the case of hidden (internal) rectal prolapse.
Fecal incontinence leading to soiled clothing. Incontinence of gas, loose and hard stools, or mucus/blood may also occur.
Constipation is noted in up to 30-50% of patients with rectal prolapse. Constipation can occur due to congestion in the rectum, creating a blockage that gets worse with strain.
Pain and discomfort in the anus.
Bleeding – Over time, the prolapsed mucosa can become thick and ulcerated, causing bleeding.

Herbal laxatives

There are different types of herbal laxatives - some of them are called bulk laxatives, others are classified as stimulants. Bulk ones act on the principle of dietary fiber: they absorb and retain water in the intestines, increase the volume of feces, soften them and promote gentle excretion.

Functional problems with stool in women in the absence of organic pathologies and other serious causes can be easily corrected with bulk laxatives of plant origin. In some cases, fiber supplementation or laxatives may be sufficient. You can take them for a long time.

For example, doctors Parfenov A.I., Ruchkina I.N., Silvestrova S.Yu. emphasize that “volumetric agents are acceptable for long-term use. They act slowly, gently and are safe for the systematic support of normal stool” (Parfenov A.I., Ruchkina I.N., Silvestrova S.Yu., p. 109).

One of these herbal preparations is the British drug “Fitomucil Norm”. It contains the pulp of plum fruit, the shell of plantain seeds, which is called Psyllium - soluble and insoluble fiber. The former dissolve in the intestines and turn into a mucous gel due to the absorption of water, the latter gently stimulate the intestinal walls and its motility, this leads to the desired effect. The drug acts gently, predictably, and does not provoke spasms and pain, as well as the appearance of the so-called drastic effect - diarrhea.

Stimulating herbal preparations based on senna, buckthorn, and rhubarb act on intestinal receptors. They are very fast and powerful, sometimes work unpredictably and cause diarrhea with severe pain and abdominal cramps. They have a large list of contraindications, so such herbal remedies should be used under the supervision of a doctor. Using them constantly or regularly is prohibited in almost all clinical cases.

Diagnostics

In most cases, an experienced doctor will be able to make a diagnosis during the initial examination. However, there are additional research methods that can assess the severity of the disease and help in the correct choice of a particular treatment method.

Studies that may be required to determine the severity of rectal prolapse:

Anal electromyography. This test determines whether nerve damage is causing the anal sphincters to not work properly. It also covers coordination of the rectum and anal muscles.
Anal manometry. This test examines the strength of the anal sphincter muscles. The study allows you to evaluate the holding function.
Transrectal ultrasound examination. This test helps evaluate the shape and structure of the anal sphincter muscles and surrounding tissues.
Proctography (defecography). This test evaluates how well the rectum holds stool and how well the rectum empties.
Colonoscopy. Allows you to visually examine the entire colon and helps identify certain problems.

Our Clinic has all the necessary diagnostic services. We also work closely with urologists and gynecologists from other departments of Sechenov University, which allows us to approach the issue of treating rectal prolapse multidisciplinary, that is, jointly.

Surgical treatment

This method is considered the only effective one for this disease. It involves surgical intervention for hernia removal.

There is only one type of disease that can resolve on its own. This is a baby umbilical hernia. Adults don't have it. It is typical for children under five years of age. In another case, if the operation is not performed, the pathology may increase and cause a threat to human health.

At the first symptoms, you need to immediately go to the surgeon in order not to start the disease. If the operation is performed on time, there is a high chance of recovery.

Treatment of rectal prolapse

Our Clinic provides the full range of treatment for rectal prolapse. Based on the stage of the disease and its manifestations, our specialists select the most optimal treatment method. It is important to understand that rectal prolapse is a complex disease that cannot be treated without surgery. To treat rectal prolapse, our Clinic uses the following surgical techniques:

Abdominal surgeries (surgeries through the abdominal cavity)

1. Operation rectosacropexy - it uses a mesh allograft (alloprosthesis), which holds the intestine in a given position. During the operation, the rectum is mobilized to the level of the levator ani muscles, then the rectum is pulled up and fixed to the presacral fascia, located between the sacrum and the rectum, using a mesh allograft.

2. Kümmel’s operation is the fixation of the previously mobilized rectum to the promontory of the sacrum with interrupted sutures.

These operations can be performed either openly through incisions (laparotomy) or laparoscopically through small punctures.

Transanal operations (operations through the anal canal)

1. Delorme's operation is the removal (resection) of the mucous membrane of a prolapsed section of the intestine with the formation of a muscular cuff that holds the intestine, protecting it from prolapse.

2. Altmeer's operation - resection of the rectum or its prolapsed section with the formation of a coloanal anastomosis - joining the colon to the anal canal.

Surgical treatment in most cases allows patients to completely get rid of the symptoms of rectal prolapse. The success of treatment depends on the type of prolapse - internal or external, on the general condition of the patient and on the degree of neglect of the disease. Patients may need some time to regain gastrointestinal function. After surgery, it is important to control bowel movements, avoid constipation and severe straining.

What to expect after surgical correction

You will have a gauze bandage placed in your vagina to help stop the bleeding. The bandage will be removed the day after surgery.
Urine will be drained from the bladder using a catheter. Your nurse will remove it the day after surgery.
After surgery, you may experience some vaginal bleeding. Use regular or panty liners. Don't use tampons.
You can shower 48 hours after surgery. Do not bathe, swim, or use a hot tub until your doctor or nurse says it is safe to do so.

Take your medications

After surgery you will need to take 3 medications:

An antibiotic that you must take until all the tablets in the package are gone.
Medicine to relieve pain after surgery.
A stool softener to ease bowel movements. You may stop taking it if you develop diarrhea (loose or watery stools).

Follow-up

Make an appointment with your doctor 2 weeks after surgery.
Do not lift anything heavier than 10 pounds (4.5 kg) for 3 months after surgery.
Avoid strenuous physical activity such as running, including jogging, for 3 months after surgery.
Do not have sexual intercourse or insert anything into the vagina (such as tampons) for 6 weeks after surgery.

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