What is Rectal Prolapse?
BDS (Bachelor of Dental Surgery), 10 years of experience
What is the meaning of Rectal Prolapse?
Rectal prolapse is a condition that occurs when the rectum, which is the last portion of the large intestine, falls from its normal position within the pelvic area and sticks out through the anus, which is the opening through which the stools exit the body. The rectum is the last part of the large intestine where the feces is stored before being removed from the body.
Rectal prolapse occurs when the rectum becomes unattached inside the body and sticks out through the anus, thus turning itself inside out. Rectal prolapse is a rare condition and becomes noticeable gradually with time. It is usually associated with weak muscles in the pelvis (the region below the stomach).
In today’s article, we will be discussing in detail about rectal prolapse.
- What are the types of Rectal Prolapse?
- What are the causes of Rectal Prolapse?
- What are the risk factors of Rectal Prolapse?
- What are the symptoms of Rectal Prolapse?
- What are the complications of Rectal Prolapse?
- How to diagnose Rectal Prolapse?
- What is the treatment of Rectal Prolapse?
- How to care after surgery for Rectal Prolapse?
- What are the risks of surgery for Rectal Prolapse?
- How to prevent Rectal Prolapse?
- What is the cost of Rectal Prolapse treatment in India?
What are the types of Rectal Prolapse?
The different types of rectal prolapse include:
- Full-thickness prolapse: The full-thickness rectal wall sticks out of the anus in this type of rectal prolapse. It is the most common kind of rectal prolapse and may involve complete or partial protrusion of the rectum.
- Mucosal prolapse: In this type of rectal prolapse, only the rectum lining, known as the mucosa, sticks out of the anus.
- Internal prolapse: In this type, the rectum tends to fold in on itself, but does not stick out of the anus. ( Know more about- What is Anal Fissure Surgery? )
What are the causes of Rectal Prolapse?
Rectal prolapse can be caused due to:
- Damage of the nerves controlling the anal and rectal muscles: This is usually seen in cases of pregnancy, spinal (backbone) injury, difficult vaginal childbirth, spinal surgery, and other surgeries involving the pelvic area.
- Weakened anal sphincter: Anal sphincter is the muscle preventing the stool from involuntarily passing from the rectum. The anal sphincter may be weakened during childbirth, increase in age, and pregnancy.
- Chronic (long-term) constipation or chronic diarrhea
- Older age
- History of an injury to the pelvic or anal areas
- Other disorders: Rectal prolapse can be seen in conditions like diabetes, chronic obstructive pulmonary disorder (a breathing disorder affecting the lungs), poor nutrition, hysterectomy (surgical removal of the uterus or womb), cystic fibrosis (an inherited condition that results in damage to the lungs and the digestive system), and parasitic infections in the intestines.
What are the risk factors of Rectal Prolapse?
Certain factors increase the risk of developing rectal prolapse. These factors include:
- Age over 50 years
- More common in women
- Chronic constipation (Know more about- What causes Constipation? How to find a solution? )
- Chronic diarrhea
- Pregnancy
- Cystic fibrosis
- Difficult vaginal childbirth
- Spinal cord disorders ( Know more about- What is a Slipped Disc? )
- Hysterectomy
- Stroke (blood flow to the brain is stopped)
- Dementia (a condition characterized by the loss of judgement and memory)
- Chronic obstructive pulmonary disorder
- Hysterectomy
What are the symptoms of Rectal Prolapse?
The symptoms of rectal prolapse include:
- Swelling or lump coming out of the anus when having a bowel movement
- Difficulty in controlling bowel movements (fecal incontinence)
- Discomfort
- Constipation or diarrhea
- Leaking of mucus or blood from the rectum ( Know more about- What is Blood in Stools? )
- The feeling of rectum not being empty after a bowel movement
What are the complications of Rectal Prolapse?
Rectal prolapse, if left untreated, can cause the following complications:
- Damage of the rectum, like bleeding or ulceration
- Inability to manually push the rectum back inside the body (incarceration)
- Reduction of blood supply to the rectum (strangulation)
- Gangrene (decay and death of the strangulated rectal tissue)
How to diagnose Rectal Prolapse?
- Physical examination: The doctor will physically examine the patient, and note down the symptoms and medical history of the patient.
- Rectal exam: The doctor will insert his lubricated and gloved finger into the rectum to check the rectum and anus.
- Anal electromyography (EMG): This test helps in checking for any nerve damage that may be responsible for the anal sphincter’s not working well. It also helps in checking the coordination between the anal and rectal muscles.
- Anal manometry: This test helps to check the strength of the anal sphincter muscles. A thin, short tube is inserted into the anus and rectum to measure the tightness of the sphincter.
- Anal ultrasound: This test is done by the insertion of a small probe into the anus and rectum for obtaining the images of the sphincters. This helps in checking the shape and structure of the anal sphincter muscles and the surrounding tissue.
- Pudendal nerve terminal motor latency test: The function of the pudendal nerves (nerves involved in the control of the bowels) is measured by this test.
- Colonoscopy: A flexible tube with a camera on one end is passed through the anus up to the junction of the large intestine and small intestine. This helps in obtaining the images of the colon or large intestine. ( Know more about- What is Colonoscopy? )
- Proctography or defecography: An x-ray video is taken to show how well the rectum is functioning. This helps in checking how much stool can be held by the rectum, how well can the rectum hold the stools, and how well can the rectum release the stools.
- Proctosigmoidoscopy: This test is done by inserting a flexible tube with a camera into the rectum up to the sigmoid colon (part of the large intestine). It helps in the evaluation of the lower portion of the colon, and check for the presence of any tumor, scar tissue, or inflammation. (Know more about- What is Colon Cancer? )
- Magnetic resonance imaging (MRI): This is an imaging test done to obtain the images of the organs present in the pelvic region.
What is the treatment of Rectal Prolapse?
Treatment for rectal prolapse depends on several factors like the severity of the condition, the age of the patient, and whether any other abnormalities are present along with rectal prolapse. The different treatment options include:
Lifestyle and diet changes for treatment of chronic constipation, like eating fiber-rich foods including fruits, vegetables, and wholegrain foods, increase in fluid intake, not straining during bowel movements, using laxatives, and regular exercise. This form of treatment is usually enough to treat rectal prolapse in young children.
- In case of a mucosal prolapse, the structures are secured in place using surgical rubber bands.
- Surgery: Surgery may sometimes be used for securing the rectum into place. The surgery can be performed by either abdominal or rectal (or perineal) approach as follows:
Abdominal repair approaches:
- The procedure is generally performed under general anesthesia (patient is put to sleep during the procedure), and the procedure is generally done in healthy adults.
- An incision is made in the abdominal muscles.
- The two most common types of abdominal repairs are rectopexy (reattachment of the rectum), and resection (removal of a segment of the intestine followed by rectopexy.
The surgery can be performed in the following ways:
- Laparotomy (open abdominal surgery): A single large incision (cut) is made in the abdomen by the surgeon. The overlying organs are carefully moved aside. The rectum is pulled straight and stitched directly to the inner surface of the sacrum (the central bone of the pelvis). A short length of the bowel may be removed.
- Laparoscopy (keyhole abdominal surgery): This procedure involves the insertion of slender instruments through several small incisions in the abdomen. Recovery time after a laparoscopy procedure is quicker as compared to open surgery.
Rectal (perineal) repair procedures:
- This procedure is usually performed under general anesthesia or an epidural (anesthesia blocking pain in certain parts of the body).
- This procedure is usually performed in older patients or patients having medical conditions.
The most common rectal approaches include:
- Altemeier procedure: Also known as perineal proctosigmoidectomy, this procedure involves cutting off (amputating) the portion of the rectum that extends out of the anus and stitching the two ends back together. The remaining structures that support the rectum are also stitched back together.
- Delorme procedure: This procedure involves the removal of only the inner lining of the rectum. The outer layer of the rectum is then folded and stitched. The cut edges of the inner lining are also stitched together so that the rectum gets enclosed inside the anal canal.
How to care after surgery for Rectal Prolapse?
- The doctor may prescribe pain-relieving medications after the procedure.
- If a vaginal pack has been given, it will be taken out later on the same day or the following day after the surgery.
- You will be in the hospital for three to six days after the surgery.
- The doctor recommends taking rest after the procedure.
- Avoid strenuous activities or lifting heavy objects for a few weeks after the surgery.
- Avoid straining when passing stools.
- Try to prevent getting constipated, by eating a high-fiber diet and drinking lots of fluids.
- It is normal to notice bloody vaginal discharge for approximately four weeks after rectocele surgery.
- Contact your doctor immediately if you notice symptoms like heavy bleeding, fever, difficulty in urinating, or signs of infection in and around the wound area.
- You can return to work six weeks after the surgery.
- Follow-up appointments with your doctor are a must.
What are the risks of surgery for Rectal Prolapse?
The various risks associated with rectal prolapse surgery include:
- Allergic reaction to anesthesia
- Hemorrhage (bleeding)
- Infection
- Injury to the surrounding blood vessels or nerves
- Damage to pelvic organs like the rectum or bladder
- Necrosis (death) of the rectal wall
- Recurrence of rectal prolapse
- Fever
- Difficulty in urination
How to prevent Rectal Prolapse?
Certain lifestyle changes may help in the prevention of rectal prolapse. These include:
- Eat a fiber-rich diet including beans, fruits, vegetables, bran
- Avoid processed food
- Drink lots of fluids
- Avoid straining during a bowel movement
- Exercise regularly
- Maintain a healthy body weight ( Know more about- Diet Plan for Weight Loss )
- Manage stress by yoga, meditation, or other relaxation techniques
What is the cost of Rectal Prolapse Surgery in India?
The total cost of rectal prolapse surgery in India can range from around INR 30,000 to INR 1,00,000. However, many prominent hospital doctors in India specialize in rectal prolapse surgery. But the cost varies across different hospitals.
If you are coming from abroad, apart from the cost of rectal prolapse surgery, there will be an additional cost of living in a hotel and the cost of local travel. After surgery, the patient is kept for 7 days in the hospital and 15 days in the hotel for recovery. So, the total cost of rectal prolapse surgery in India comes from a total of INR 40,000 to INR 1,30,000.
We hope that we could answer all your questions regarding rectal prolapse through this article.
If you need more information and treatment of rectal prolapse, you can contact a Gastroenterologist.
We only aim to provide you with information through this article. We do not recommend any medication or treatment to anyone. Only a qualified doctor can give you the best advice and correct treatment plan.
