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Rectal
Prolapse
What is rectal prolapse?
Several factors may contribute to the development of rectal prolapse. It may come from a lifelong habit of straining to have bowel movements or as a delayed result of stresses involved in childbirth. In rare cases, there may be a genetic predisposition in some families. It seems to be a part of the ageing process in many patients who experience weakening of the ligaments that support the rectum inside the pelvis as well as loss of tightness of the anal sphincter muscle. In many female patients there is an associated weakness of the urinary bladder and the uterus. In some cases, neurological problems, such as spinal cord transection or spinal cord disease, can lead to prolapse. In most cases, however, no single cause can be identified.
Is rectal prolapse the same as haemorrhoids? Some of the symptoms may be the same. There may be bleeding and/or tissue that protrudes from the rectum. Rectal prolapse, however, involves a segment of the bowel located higher up within the body, while haemorrhoids develop near the anal opening.
The condition is diagnosed by taking a careful history and performing a complete anorectal examination. To demonstrate the prolapse, patients may be asked to "strain" as if having a bowel movement or to sit on the commode and "strain" prior to examination.
At times, however, a rectal prolapse may be "hidden" or internal. In this situation, an x-ray examination called Proctogram will be arranged. This examination, which takes x-ray pictures while the patient is having a bowel movement, can also assist in determining whether surgery may be beneficial and which operation may be appropriate.
Other tests that may be performed include Anorectal Manometry. This test is performed at the Lancaster Suite and measures whether or not the muscles around the anus are functioning normally. Endoanal Ultrasound is a test, which examines the appearance of the muscles around the anus. It is usually useful in detecting any damage to the muscle, which may have occurred during childbirth or previous surgery to the anus. Urodynamic Studies may be recommended to evaluate the function of the urinary bladder.
Although constipation and straining may be causes of rectal prolapse, simply correcting these problems may not improve the prolapse once it has developed. There are many different ways to surgically correct rectal prolapse.
Abdominal or anorectal (perineal) surgery may be suggested. Mr Abulafi or a member of his team will help you decide which method is most likely achieve the best result for you by taking into account many factors, such as age, physical condition, extent of prolapse and the results of various tests. If these tests show associated genital prolapse and urinary bladder weakness Mr Abulafi will arrange for a gynaecologist to be present at the operation to correct these problems at the same time as your rectal prolapse surgery.
How successful is treatment? Success depends on a number of factors, including the status of a patient's anal sphincter muscle before surgery, whether the prolapse is internal or external, the overall condition of the patient and surgical method used. If the anal muscle has been weakened, either because of the rectal prolapse or for some other reason, it may in many cases significantly regain strength after the rectal prolapse has been corrected. One common side effect of operations undertaken via the abdominal route is constipation and many patients will require some form of laxatives to be taken long term. Chronic constipation and straining after surgical correction must be avoided. A great majority of patients are completely relieved of symptoms, or are significantly helped, by the appropriate procedure.
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Rectal prolapse is a condition in which the rectum (the
lower end of the colon, located just above the anus) turns itself inside
out. In the earliest phases of this condition, the rectum does not stick
out of the body, but as the condition worsens, it may protrude. Weakness
of the anal sphincter muscle is often associated with rectal prolapse
at this stage and may result in leakage of stool or mucus. The condition
occurs in both sexes, although it is more common in women than men.