Rectal Prolapse: An Overview

Rectal prolapse is a medical condition in which the rectum, the final section of the large intestine, loses its normal attachments and slides out of the anus. It can cause discomfort, incontinence, and embarrassment if untreated. Though more common in older adults, particularly women, rectal prolapse can affect people of all ages.

Condition Name:
Rectal Prolapse

Also Known As:
Prolapse of the rectum

Symptoms:
- A visible protrusion of the rectum through the anus
- Sensation of a bulge or something falling out of the anus
- Inability to control bowel movements (fecal incontinence)
- Mucus discharge from the anus
- Rectal bleeding or pain
- Constipation or straining during bowel movements

Causes:
- Chronic constipation or straining
- Weak pelvic floor muscles, often due to childbirth
- Aging, which weakens muscles and ligaments in the rectal area
- Nerve damage from spinal cord injuries or neurological disorders
- Previous surgery or trauma to the pelvic region
- Chronic diarrhea or other bowel disorders

Diagnosis:
- Physical examination: Doctors can often diagnose rectal prolapse through visual inspection and a rectal exam.
- Imaging tests: MRI, defecography, or colonoscopy may be used to assess the extent of the prolapse and rule out other conditions.
- Medical history: Evaluating past bowel habits and any symptoms of incontinence or constipation.

Treated by:
Colorectal surgeon, Gastroenterologist

Treatment Options:
Treatment for rectal prolapse often requires surgery, although the approach can vary depending on the severity of the prolapse and the patient’s overall health.

- Non-surgical treatments:
  - Dietary changes: Increasing fiber intake to reduce straining during bowel movements.
  - Pelvic floor exercises (Kegels): To strengthen the muscles supporting the rectum.
  - Stool softeners or laxatives: To prevent constipation.
  
- Surgical treatments:
  - Rectopexy: Reattaching the rectum to its normal position using sutures or mesh.
  - Perineal rectosigmoidectomy (Altemeier procedure): Removal of the prolapsed section of the rectum.
  - Laparoscopic or robotic surgery: Minimally invasive techniques to correct the prolapse.
  
What is Rectal Prolapse?

Rectal prolapse occurs when the rectum, which is typically supported by the muscles and ligaments in the pelvis, slips out of place and protrudes through the anus. It can be partial (only part of the rectal lining protrudes) or complete (the entire rectum protrudes). Although not life-threatening, rectal prolapse can significantly impact quality of life, causing discomfort, difficulty in bowel movements, and loss of bowel control.

Commonly Affected Groups:
- Older adults, especially women over the age of 50
- Individuals with chronic constipation or bowel movement difficulties
- People with a history of pelvic surgery or trauma
- Patients with neurological disorders or spinal cord injuries

Results and Recovery:
Recovery from rectal prolapse surgery typically takes several weeks, with patients encouraged to follow a high-fiber diet and avoid heavy lifting or straining during recovery. Most patients experience a significant improvement in symptoms, and the likelihood of recurrence is low if properly treated.

Prevention:
To reduce the risk of rectal prolapse:
- Maintain a diet rich in fiber to prevent constipation and straining.
- Perform regular pelvic floor exercises to strengthen the muscles supporting the rectum.
- Avoid prolonged straining during bowel movements.
- Seek treatment for chronic constipation or bowel disorders early.

Rectal prolapse is a manageable condition with appropriate medical care, and surgery often provides long-term relief. Early diagnosis and treatment can prevent complications and improve quality of life.