A rectal prolapse, or prolapsed rectum, occurs when part of the large intestine at the bottom (rectum) slips out of the muscular opening at the end of the digestive tract (anus). Surgery is usually required to treat a rectal prolapse.
What is a rectal prolapse?
A rectal prolapse is a rare condition and mostly affects older people. The disease is rather rare in children, affected children are usually younger than 3 years. Men are much less likely to develop a rectal prolapse than women (80-90% chance). For meanings of connective tissue weakness, please visit bestitude.com.
The disease affects the rectum, ie the last 12-15 centimeters of the large intestine just above the anal canal. Normally, the rectum is securely attached to the pelvis by ligaments and muscles. Various factors such as age, long-term constipation or stress during childbirth can weaken them. This causes the rectum to prolapse, ie fall out of its natural opening (rectal prolapse).
A rectal prolapse must be distinguished from a rectocele, which refers to a bulging of the rectrum into the vaginal walls. Another form of rectal prolapse is called intussusception. In this case, one section of the intestine turns inside another, which can result in an intestinal blockage.
A rectal prolapse is caused by a weakening of the muscles that hold the rectum in place. In most people with a rectal prolapse, the anal sphincter is also weak.
The exact cause of this weakening is unknown, but risk factors for rectal prolapse usually include advanced age, prolonged constipation or persistent diarrhea, straining to pass stool, pregnancy, and stress during childbirth. Causes of a rectal prolapse can also be previous operations, cystic fibrosis or chronic diseases.
These include lung diseases, whooping cough, multiple sclerosis and long-lasting haemorrhoids. Children with a rectal prolapse should also be checked for cystic fibrosis, as this can be a symptom of this disease.
Symptoms, Ailments & Signs
A rectal prolapse presents with several symptoms, whereby a slight and incomplete prolapse can easily be mistaken for haemorrhoids. The main symptom of a rectal prolapse is the rectum that has come out and turned outwards. A distinction is made between a rectum that has just protruded outwards and the presence of an intussusception. The latter means an invagination in itself, whereby an invagination of the intestine in itself can also lead to a prolapse.
Since the mucous membranes of the intestines reach the outside, those affected experience a permanent feeling of moisture. Sometimes bleeding occurs because the extruded rectum is injured by clothing or manual manipulation. A foreign body sensation at the anus is often described by those affected. Itching often occurs, which can sometimes be explained by the resulting inflammation.
A prolapsed rectum almost always leads to symptoms of incontinence. This can lead to uncontrolled discharge of feces or mucus. The incontinence is more pronounced, the more severe the incident is. A complete rectal prolapse almost always means fecal incontinence. A partial prolapse, on the other hand, does not necessarily mean faecal incontinence, but it does lead to the loss of mucus. A rectal prolapse can also be visually recognized very clearly.
Diagnosis & History
In the early stages of a rectal prolapse, the rectum gradually detaches but remains in the body. This stage of rectal prolapse, when the connective tissue of the rectal lining breaks loose and protrudes from the anus, is called mucosal prolapse.
The further the rectum prolapses, the more part of the rectum presses on and weakens the anus. This stage is called complete rectal prolapse and is the most common diagnostic stage of the disease. Symptoms of a rectal prolapse are similar to those of hemorrhoids and range from painful stool, mucus or blood from protruding tissue to fecal incontinence or loss of the urge to defecate.
To diagnose an earlier stage when the rectum is not yet protruding from the anus, the doctor may give a phosphate enema to distinguish rectal prolapse from protruding hemorrhoids. Using a dynamic MRI, the entire pelvis, including the pelvic floor muscles and pelvic organs, can be scanned during bowel movements.
A rectal prolapse or prolapsed rectum almost always requires surgery to avoid complications. Surgeries are usually not necessary for children. However, mostly older people suffer from a rectal prolapse. Due to the progressively increasing weakness of the connective tissue, self-healing no longer takes place here.
If the rectal prolapse occurs in children, there is usually another serious disease behind it, which also promotes the development of complications. Affected children should be examined for cystic fibrosis, among other things. The much more common cases of rectal prolapse in older people always develop complications over time if the condition is left untreated.
However, life-threatening complications are the exception. As a rule, the rectum is not clamped because the intestine can always be pushed back. However, this can happen in exceptional cases. This is a life-threatening emergency that requires immediate surgical intervention to prevent the relevant section of the rectum from dying off.
In the other cases, there is no emergency, but a surgical intervention is still necessary, because an untreated rectal prolapse leads to increasing pain during bowel movements and blood and mucus in the stool, as well as faecal incontinence in the long term. The later the treatment takes place, the more serious the associated complications are. Ulcers can also form in the rectum.
When should you go to the doctor?
An experienced doctor can spot a prolapsed rectum at a glance. Rectal prolapse, also known as extended anal prolapse, is common in older women. He absolutely requires a doctor’s visit, since parts of the intestine have leaked through the anal opening.
The preliminary stages of this phenomenon were mostly ignored and triggered by pressing too hard on the toilet. They may not go unnoticed, as often only a few small folds of the rectum are protruded. For this reason, a visit to the doctor is often omitted if the symptoms are minor. However, as an advanced anal prolapse, a prolapsed rectum cannot go unnoticed.
A rectal prolapse can occur from just heavy lifting or a coughing fit. If left untreated, the rectal prolapse will remain permanently. He needs surgical treatment. In the case of a prolapsed rectum, larger parts of the rectum and rectum have already leaked out due to a weak pelvic floor or as a result of an illness. As a result, the stool can no longer be held in the intestines. Bowel incontinence occurs.
Even before a rectal prolapse occurs, a visit to the doctor should be considered. Treatment options are greater the earlier treatment is started. If you keep getting the feeling that the anus has protruded a little after a bowel movement, you shouldn’t put off a visit to the doctor any longer. For prophylaxis, women over 40 should start with pelvic floor training.
Treatment & Therapy
Almost all cases of rectal prolapse require medical attention. Occasionally, successful treatment of the underlying cause of a rectal prolapse will resolve the problem, most often a rectal prolapse will get worse without surgery.
In infants and young children, reducing or diluting the bowel movements under medical supervision can help. Medical treatment begins to temporarily relieve symptoms of a rectal prolapse or to prepare the person for surgery. Bulking agents (bran, psyllium, methylcellulose or psyllium), stool softeners or enemas are used for this purpose.
The goal of all surgical techniques to correct a rectal prolapse is to reattach the rectum to the inner pelvis. This procedure under general anesthesia is more likely to be performed through the abdominal wall in healthy and younger patients, and through the perineum in the elderly or in poor health, which generally requires a hospital stay of three to seven days.
Eating a high-fiber diet and drinking enough fluids each day can reduce the risk of developing constipation and thus reduce a risk factor for rectal prolapse. Biofeedback therapies train the pelvic floor muscles and strengthen the sphincter. People with persistent diarrhea, constipation, or hemorrhoids should treat them in a timely manner to eliminate the risk of rectal prolapse.
Rectal prolapse (prolapsed rectum) requires consistent follow-up care, regardless of whether it was treated conservatively or surgically. Essentially, it is important to avoid the condition coming back or getting worse. The gastroenterologist and proctologist, but also the family doctor, are the professional contacts for this. In addition, there are self-help groups for people with proctological diseases that can offer a sensitive exchange of experiences and helpful tips.
Stool regulation is particularly important in the aftercare of a prolapsed rectum or rectal prolapse. Pressure during defecation must be avoided in any case. A (not too) soft and bulky stool is ideal to avoid straining. Fruit and vegetables are suitable here, especially fiber in the diet.
It is essential to ensure that you drink enough (usually around 1.5 to 2 liters of water or herbal tea). If this diet is not sufficient for stool regulation, natural helpers can be used with psyllium husks. It is better to avoid constipating foods such as chocolate or eggs for a while.
Movement is also important for stool regulation. Light endurance sports and going for walks are recommended in this context. Gymnastics and yoga can also activate intestinal movements. Prolonged sitting on the toilet should be avoided, as should overactive pressing.
You can do that yourself
Rectum prolapse or prolapsed rectum is a disease whose diagnosis and treatment should be in the hands of professionals. Nevertheless, self-help by patients in everyday life is possible and desirable. The active cooperation of the patient can prevent rectal prolapse and provide targeted support for both therapy and aftercare.
In many cases, rectal prolapse is caused by straining during bowel movements and weakness of the connective tissue in the area of the pelvic floor. This is where self-help can start. Constipation must be avoided at all costs, so that the regulation of stool plays an important role in the patient’s everyday life. This is achieved by eating a high-fiber diet in conjunction with drinking enough water. Consuming food should be eliminated from the diet plan as much as possible. A lot of exercise is also important, since physical activity stimulates the intestinal activity of those affected and can thus have a beneficial effect on rectal prolapse. Massages of the abdominal area and warm baths for constipation are also recommended, as are flea seed preparations.
The pelvic floor can be trained well with suitable exercises. The exercises are taught by the physiotherapist or the doctor treating you and can be carried out at home on a daily basis. Regular check-ups with the doctor are also important if a prolapsed rectum has been diagnosed and treated. Shame is a major obstacle here to discovering an incident (even a recurrence) as soon as possible and having it treated promptly and effectively.