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Rectal Prolapse

General SurgeryGastroenterology Hepatology

Rectal prolapse refers to the partial or complete protrusion of the rectum falling or descending below the anal opening. Rectal prolapse can lead to faecal incontinence, and the exposed rectal mucosa is susceptible to bacterial infection, increasing the risk of disease.

Symptoms

Rectal prolapse can be classified into Internal intussusception and External prolapse, with progressive symptoms. Patients may feel a protrusion in the anus, and the prolapse condition may gradually worsen. The inner layer of the rectum may bleed, and severe cases may lead to loss of bowel control.

Internal intussusception: The rectum prolapses but has not passed through the anus, or only a tiny part of the rectum has passed through the anus. (<2cm)
External prolapse: The entire rectum prolapses and passes through the anus. (>2cm)

Factors

Rectal prolapse is mainly caused by the weakening and shrinking of the pelvic floor muscles and ligaments that support the rectum in maintaining its original position. The causes and risk factors may include:

Weakness of the Pelvic Floor Muscles	The weakening of the pelvic floor muscles can prevent them from maintaining the normal position of visceral organs, leading to rectal prolapse.
Age Factors	With increasing age, the elasticity and tension of muscles and tissues may decrease, increasing the risk of rectal prolapse.
Childbirth and Pregnancy	Women who undergo multiple childbirths, especially vaginal deliveries, may increase pressure on the pelvic floor, raising the risk of rectal prolapse.
Constipation	Long-term constipation and straining during bowel movements can increase abdominal pressure, putting additional stress on the pelvic floor muscles and promoting rectal prolapse.
Genetic Factors	Genetics may play a role in influencing pelvic floor structure and function, contributing to the risk of rectal prolapse.
Surgical History	Certain surgeries, particularly those involving the pelvic region, may cause damage to the pelvic floor muscles, increasing the risk of rectal prolapse.
Chronic Cough	Persistent chronic cough, such as that caused by smoking, can increase abdominal pressure, adding extra burden to the pelvic floor.

Diagnosis and Treaments

Diagnosis

Doctors can visually and manually examine patients to determine whether they have rectal prolapse.
In some cases, doctors may use colonoscopy or imaging studies (abdominal ultrasound, MRI, CT scan, or defecography) to gain a more comprehensive understanding of abdominal and pelvic structures and diagnose any issues with the muscle wall separating the rectum and vagina.

Treatment

Rectal mucosal prolapse: Doctors can use manual pressure to push the prolapsed part of the rectum back into the anus.
External rectal prolapse: Surgical intervention, either through perianal surgery or abdominal surgery, can be performed for "repositioning." For severe cases, partial rectal resection may be necessary to alleviate prolapse symptoms.

FAQ

No. Mucosal prolapse refers to the protrusion of only the epithelium covered with mucosa. Rectal prolapse refers to the entire rectum turning inside out and protruding.