What is rectal prolapse?
It is a condition in which the rectum, which is the lower part of the colon and connects to the anus, becomes stretched out and eventually protrudes out of the anus. Anal sphincter weakness is often associated with rectal prolapse, leading to leakage of mucous or stool. Although it is seen in both sexes, it is common in women.
Why does it happen?
There are many factors that contribute to the development of rectal prolapse. It can come from prolonged straining to have a bowel movement over a long period of time, as one of the later consequences of childbirth, a genetic predisposition, or part of the aging process in which the ligaments supporting the rectum in the pelvis become stretched in addition to the weakness of the anal sphincter muscle. Pelvic floor dysfunction can lead to rectal prolapse. Sometimes it can be associated with urinary incontinence and pelvic organ prolapsed as well. Neurological problems can also lead to prolapse. However, in most instances, there are multiple causes for the rectal prolapse.
Is rectal prolapsed the same as hemorrhoids?
They are not the same but can present with similar symptoms. Bleeding and /or tissue protruding from the anus can be seen in both, but rectal prolapse involves protrusion of the bowel located higher in the body while hemorrhoids protrude from near the anal opening.
How do you make the diagnosis of rectal prolapse?
With a carefully history and complete anorectal examination we can often diagnose the condition in the office. In the office you may be asked to sit on the toilet and “push” as if you having a bowel movement to demonstrate the rectal prolapse.
If it is an “internal” prolapse or “hidden”, the diagnosis may require further studies such as defecography or dynamic pelvic floor MRI. Other examinations could also include anorectal manometry and endorectal ultrasound to evaluate the function of the muscles around the rectum as they relate to having a bowel movement and to look at the sphincter complex if there is an element of incontinence and stretching of the anal sphincter.
How is it treated?
Initially the constipation and straining need to be addressed as they contribute to the rectal prolapse; usually this is not enough once this has developed and surgery will be required to treat the prolapse.
There are 2 approaches to surgery: an abdominal approach and a rectal approach. An abdominal approach can often times be done laparscopically or robotically and may include a resection of the redundant intestine. The decision on which approach will be recommended is determined by many factors, including age, physical condition, the extent of prolapse, the results of the various studies, and any other associated pelvic floor problems.
How successful is the treatment for rectal prolapse?
The majority of patients have their symptoms competely resolved or are significantly helped by the appropriate procedure for rectal prolapse. It depends on many factors, including the status of the patient’s anal sphincter, whether the prolapsed is internal or external, and the overall physical condition of the patient.
Our Board Certified Colon and Rectal Surgeons can help diagnose and treat rectal prolapse in any of our offices located throughout Long Island.