Rectal prolapse represents a significant obstacle to health and well-being, creating a considerable impact on the daily lives of those who experience it. Let’s explore this medical condition together, which entails not only severe physical consequences but also emotional ones, requiring an in-depth look into its origins, the signs it manifests, diagnostic methods, and available treatment options.
What is rectal prolapse?
Rectal prolapse is a painful and debilitating condition characterized by the outward sliding of the wall of the rectum (the terminal part of the large intestine), protruding through the anal opening. This pathology can severely compromise the quality of life for affected patients, both physically and psychologically, negatively impacting social relationships and work productivity. It should be noted that rectal prolapse can affect both males and females, but it is six times more common in females. However, this does not exclude the possibility that men can also be affected by the same condition and experience similar symptoms and complications.
Predisposing Factors
Rectal prolapse can be attributed to a series of factors that contribute to the deterioration of the structure and function of the tissues involved in the integrity of the rectum and anus. The main causes include:
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1. Weakness of the muscles that play a fundamental role in supporting the pelvic organs, including the rectum.
- Internal: the rectum folds inward into one or more parts and protrudes through the anal opening but does not protrude outside the body.
- External: the rectum protrudes through the anal opening and emerges fully outside the body (≥ 10 cm).
- Partial: the prolapse involves only a part of the rectum rather than the entire intestinal wall.
Complete: the rectum protrudes fully outside the body through the anal opening. - Complete: the rectum protrudes fully outside the body through the anal opening.
- Mucosal: this form primarily involves the mucous lining of the rectum rather than the entire intestinal wall.
- Complete with mucosal overlap: both the mucosal lining and the muscular wall of the rectum are involved in the prolapse.
- Hemorrhoids.
- Anal itching.
- Abdominal and sacral pain.
- Constipation.
- Feeling of a lump or swelling outside the anus.
- Feeling of incomplete emptying of the bowel.
- Tenesmus (the sensation of needing to evacuate even when there is no stool to pass).
- Involuntary leakage of gas and feces.
- Bleeding, mucus discharge, and moist anus.
- Appearance of tissue protruding from the rectum (initially occurring only after straining during bowel movements, becoming more frequent with stimuli like sneezing or coughing, and eventually being constantly present in advanced stages of the condition).
2. Pregnancy and childbirth, which can cause excessive weakening of the ligamentous and muscular structures of the pelvic floor and often contribute to a multi-compartment situation with associated rectal prolapse along with uterine and bladder prolapse (cystocele).
3. Chronic constipation, where excessive and constant straining during defecation can put undue stress on the muscles and tissues of the rectum, increasing the risk of prolapse.
4. Chronic diarrhea, which similarly to constipation, can exert pressure on the pelvic floor muscles and rectum.
5. Aging and consequent loss of elasticity and strength of tissues, including those of the rectum and anus.
6. Genetic factors due to structural abnormalities or heredity.
7. Obesity, as excess weight can increase pressure on the pelvic muscles and tissues.
8. Previous pelvic surgeries that may weaken tissues and muscles, predisposing to prolapse.
Classification of rectal prolapse
The classification of rectal prolapse is of fundamental importance in the context of assessing and treating the condition. By categorizing the different degrees of prolapse, medical professionals can not only determine the severity of the situation but also adopt a targeted and personalized therapeutic approach. Rectal prolapse can manifest in various forms and severities, each of which presents specific characteristics that influence the clinical picture and treatment options. The main medical classifications include:
Symptoms of rectal prolapse
The symptoms of rectal prolapse can range from mild to severe and include:
In women, along with these symptoms, there may also be manifestations typical of an altered pelvic floor, such as urinary incontinence, cystocele, uterine prolapse, rectocele, pelvic pain, and pain during sexual intercourse (dyspareunia).
Diagnosis and treatment options
The diagnosis of anorectal prolapse is performed by a proctologist through a specialist consultation, which will allow for the creation of a personalized and effective treatment plan. The proctological examination for rectal prolapse includes a physical exam and additional tests such as colonoscopy, sigmoidoscopy, proctoscopy, defecography, and anorectal manometry. Once the diagnosis is confirmed, the treatment depends on the severity of the prolapse.
In mild cases, lifestyle modifications may be recommended, such as adopting a balanced, fiber-rich diet to improve stool consistency and reduce straining during bowel movements, adequate water intake to keep stools soft and facilitate their passage through the rectum, and the use of laxatives to prevent constipation and reduce straining during bowel movements.
However, surgery may be necessary to correct the prolapse. Surgical treatment of anorectal prolapse can include various procedures, such as rectocele repair, removal of prolapsed tissue, or reconstruction of the anal support. After the surgery, it may be necessary to follow a rehabilitation program, which could include physiotherapy and lifestyle modifications, to ensure complete healing and prevent recurrence.
The contents of this page are for informational purposes only and should in no way replace the advice, diagnosis, or treatment prescribed by your physician. Responses to the same treatment may vary from patient to patient. Always consult your doctor regarding any information related to diagnoses and treatments, and meticulously follow their instructions.
