Rectal prolapse

Background 

Rectal prolapse is a condition where the lower part of the rectum comes out of the anal canal during straining on defecation. This condition can affect young individuals but more commonly presently at old age. This could be very debilitating in cases of large rectal prolapse. In older age females have higher tendency to develop rectal prolapse due to weakness of pelvic muscles. Rectal prolapse is usually categorised according to the degree of rectum coming out of the anal canal as partial, incomplete and complete. 

Common cause of rectal prolapse 

1)  chronic constipation in individuals leading to excessive straining 

  1. Weakness of pelvic muscles in females due to repeated pregnancy 
  2. Neuromuscular injuries of perineum leading to weakness of muscle
  3. Consumption of excessive  high fibre diet and over use of laxatives 

Common symptoms of rectal prolapse 

  1. Tissue coming out of anal canal during straining, walking and exercises 
  2. Ulcers and bleeding associated with prolapsed tissue 
  3. Mucous discharge via anal canal 
  4. Manual reposition of prolapse becomes uncomfortable for the patient 
  5. Incontinence ( loss of control over defecation) 
  6. Pelvic pain and local area irritation.
  7. Symptoms associated with prolapse of bladders uterus in females

Diagnosis and investigations 

Rectal prolapse is completely  surgical condition which require management by surgical means. These symptoms are considered to take visit to your clinician/ surgeon for further management. Clinical examination carries extreme importance in decision making of these cases. Patient are advised to undergo sigmoidoscopy/ colonoscopy to evaluate the large colon for any polyps/ cancer especially in old age. Routine blood investigations will be advised. Magnetic resonance( MR) defecography or MRI pelvis may be done to asses the functional component of your perineum and to rule any associated disease of other organs. 

Treatment of rectal prolapse 

Minimal invasive surgery or trans anal surgeries remain the gold standard for treatment of rectal prolapse. Choice of surgery upon the age of patient, grade of prolapse and prolapse associated symptoms. Various surgical procedures are are described in surgical practice,though commonly performed are Rceotpexy( suture/ mesh), Resection rectopexy, ventral rectopexy and trans anal procedures in children and very old age. 

These surgical procedures are extremely safe and usually patient is discharged from the hospital with in 1- 3 days. There is an immediate relief off symptoms and patient needs to follow with medications and diet as advised.

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