A rectal prolapse occurs when the rectum protrudes out of the anal opening due to stretching or disruption of its attachments to the abdominal wall.
What are the causes?
The exact cause remains unclear however, the predisposing factors include prolonged straining during bowel movement, multiple pregnancies, neurological illnesses causing muscular weakness or connective tissue disorders.
Weakness of the anal sphincter muscle is often associated with rectal prolapse, resulting in leakage of stool and mucus discharge. This condition is more common in the elderly,
What are the symptoms?
A large pink mass protruding out of the anal opening coupled with extreme pain and difficulties with bowel movements. Bleeding or mucus discharge, loss of urge to defecate and fecal incontinence may occur.
History of symptoms and physical examination confirm the diagnosis of a prolapse. In case of an internal rectal prolapse, defecography is required.
Conservative management may benefit some patients with minimal symptoms however, surgery remains the only potentially curative treatment to correct rectal prolapse. In some children and pregnant women, prolapses are known to correct themselves spontaneously.
There are three procedures available for rectal prolapse correction:
1. Perineal approach
It includes three different methods that are used depending on the nature of the prolapse.
- Minimally Invasive Procedure for Hemorrhoids (MIPH), this process is indicated only in cases of partial or mucosal prolapse.
- Altemeier procedure (also called a proctosigmoidectomy) involves removal of the prolapsed part of the rectum and suturing together the cut edges.
- Thiersch wiring is a temporary procedure wherein the anal verge is wired to narrow the opening. The procedure is poorly tolerated.
The perineal approach being minimally invasive has various advantages such as decreased operative time, less blood loss, faster recovery and less post-operative pain.
2. Abdominal approach
This approach includes two surgical processes:
- Rectopexy- Surgical fixation of the rectosigmoid to the sacrum.
- Anterior resection -The redundant part of the sigmoid is resected and removed. It may or may not be accompanied by rectopexy.
The abdominal approach also uses the laparoscopic technique. Abdominal procedures are known to give better results, of these Rectopexy is associated with a faster recovery.