Rectal prolapse is a condition in which the rectum starts coming out of the anus. The rectum is that last part of large intestine, and the anus is the opening through which stool exits our body. Rectal prolapse can range from mild to severe. Mild cases can often be treated without surgery. Severe cases may require surgery.

Symptoms

• The most common symptom is some bulge (reddish-colored) coming out of anus. In the initial stages, it happens only during passing stools.
• As time passes by, during normal physical activity, such as walking, sitting, and exercising it may tends to come out.
• In the early course of disease, this can be pushed back into the anus after defecation but latter the prolapse can be permanent.
• Mucous discharge from the anus or occasional bleeding.
• In the case of partial prolapse, there is a feeling of incomplete emptying after bowel motion.
• About half of patients complain of constipation.

Types

• Internal prolapse: The rectum starts to drop, but hasn’t yet pushed through the anus.
• Partial prolapse: Only innermost part (mucosa) of the rectum has protrudes through the anus.
• Complete prolapse: The entire rectum extends out through the anus.

Causes

Injury to nerves that control the rectal and anal muscles due to

• Pregnancy or during a difficult vaginal birth
• Spinal injury
• Surgery in the pelvic area

Weakened anal sphincter

• Pregnancy
• Childbirth
• Old age.

Chronic constipation

Straining during defecation, over a period of years, can also cause rectal prolapse.

Treatment

Rectal prolapse can be uncomfortable and painful, but it’s treatable. The sooner you see a doctor about your symptoms, the easier the surgery and recovery.

The surgeon can do the surgery through the abdomen or through the area around the anus (Perineum).

Although there are several procedures, but the type of surgery and approach depends on patient’s age, existing health problems, extent of the prolapse and his/her general health.

The abdominal approach has always better outcome.

Abdominal Approach

Rectopexy (For Complete proplapse): It is associated with best functional outcomes and minimal chance of recurrence

Open Conventional surgery: through a big incision in lower abdomen.

Laparoscopic Surgery: If patient is fit and healthy, it must undergo laparoscopic surgery as the results are far satisfying and long-lasting

3 tiny incisions of 0.5 cm are created on the belly and the rectum is pulled upwards and fixed to the sacral bone (back wall of the pelvis) either with the help of sutures directly or using a Mesh.

The basic purpose is to hold the rectum in its normal anatomical position until such a time as scarring occurs.

When patients complain of chronic or long-term constipation, removal of a part of the colon may be necessary to improve bowel function (recto-sigmoidectomy).

Perineal Approach

This approach is usually performed in people who aren’t good candidates for surgery through their abdomen.

Surgery from the region around the anus involves pulling part of the rectum out and surgically removing it. The rectum is then placed back inside and sutured to the large intestine.

STARR Procedure (Stapled Trans Anal Rectal Resection):

The procedure is performed through the anal canal (transanal approach).

It is an innovative, technically safe and minimally invasive procedure useful in carefully selected and well-informed patients having partial or internal prolapse.

The procedure resects the internal rectal prolapse by means of staplers inserted into the anal canal.

Prevention Tips

Preventing rectal prolapse isn’t always possible. You can reduce your risk if you maintain good intestinal health. To help avoid constipation, in particular:

• make high-fiber foods part of your regular diet, including fruits, vegetables, bran, and beans
• reduce the amount of processed food in your diet
• drink plenty of water and fluids every day
• exercise most, if not all, days of the week
• manage your stress with meditation or other relaxation techniques

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