WHAT IS A RECTAL PROLAPSE ?

Rectal prolapse is a medical condition in which the rectum, which is the lowest part of the large intestine, protrudes outside the anus. In other words, it is the turning inside out of the rectum and its descent through the anal opening.

WHY DO RECTAL PROLAPSE OCCURS

Rectal prolapse can occur due to a combination of factors that weaken the support structures of the rectum and the pelvic area. The main causes and contributing factors to rectal prolapse include:

1. Weak Pelvic Floor Muscles : The pelvic floor muscles and ligaments provide support to the rectum and other pelvic organs. When these muscles become weak or damaged, it can lead to the descent of the rectum.

2. Chronic Constipation : Frequent straining during bowel movements, often caused by chronic constipation, puts excessive pressure on the rectal tissues and can lead to prolapse.

3. Aging : As people age, natural changes in connective tissues and muscles can result in weakened support for the rectum and other pelvic organs.

4. Childbirth : In women, the process of giving birth can stretch and damage the pelvic floor muscles and ligaments, making them less effective in holding the rectum in place.

5. Previous Pelvic Surgery : Certain pelvic surgeries can affect the structural integrity of the pelvic area, increasing the risk of rectal prolapse.

6. Neurological Disorders : Conditions that affect the nervous system, such as multiple sclerosis, can disrupt the normal function of the muscles and nerves that control bowel movements, potentially leading to rectal
prolapse.

7. Chronic Coughing : Conditions like chronic obstructive pulmonary disease (COPD) can result in repeated, forceful coughing that may contribute to rectal prolapse.

TYPES OF RECTAL PROLAPSE 

Rectal prolapse can be categorized into three primary types based on the extent and severity of the prolapse:

1. Partial Rectal Prolapse (Mucosal Prolapse) : In a partial rectal prolapse, only the inner lining of the rectum (mucosa) protrudes through the anal opening. This type of prolapse often appears as a reddish mass or ring around the anus. It is the least severe form of rectal prolapse.

2. Complete Rectal Prolapse : In a complete rectal prolapse, the entire thickness of the rectum extends outside the anus. The rectum essentially turns inside out and protrudes. This is the most severe form of rectal prolapse and is often associated with significant discomfort and functional issues.

3. Internal Rectal Prolapse (Intussusception) : An internal rectal prolapse, also known as intussusception, occurs when a portion of the rectum folds in on itself but does not extend outside the anus. This type of prolapse can be more challenging to diagnose because it is not visible externally.

SYMPTOMS OF RECTAL PROLAPSE

Rectal prolapse can cause a range of symptoms, which may vary depending on the type and severity of the prolapse. Common symptoms of rectal prolapse include:

1. Visible Protrusion : In cases of partial or complete rectal prolapse, there may be a noticeable bulge or protrusion of the rectal tissue through the anus.

2. Discomfort : Individuals with rectal prolapse often experience discomfort or a feeling of fullness in the rectal area.

3. Pain : Rectal prolapse can cause pain, which may range from mild to severe. The pain is typically located in the lower abdominal or rectal area.

4. Bleeding : There may be rectal bleeding, often noticed when wiping after a bowel movement or in the underwear.

5. Difficulty with Bowel Movements : Some people with rectal prolapse experience difficulty with bowel movements, including straining, incomplete evacuation, or a sense of blockage.

6. Incontinence : Rectal prolapse can lead to fecal incontinence, where an individual may have difficulty controlling bowel movements.

7. Mucus Discharge : You may notice a discharge of mucus from the rectum.

8. Itching or Irritation : The prolapsed tissue can cause itching and irritation in the rectal area.

Treatment of Rectal Prolapse

 The treatment of rectal prolapse depends on the type and severity of the prolapse, as well as the individual’s overall health. Treatment options for rectal prolapse include:

1. Conservative Management :
• For mild or partial rectal prolapse, conservative approaches may be considered. These can include dietary changes to address constipation or diarrhea, pelvic floor exercises to strengthen the muscles, and lifestyle modifications.

2. Medications :
• In some cases, medications may be prescribed to help manage symptoms associated with rectal prolapse. For example, anti-diarrheal medications may be used to address chronic diarrhea.

3. Pelvic Floor Physical Therapy :
• Pelvic floor physical therapy, which includes exercises and techniques to strengthen the pelvic muscles, can be beneficial in managing rectal prolapse.

4. Biofeedback Therapy :
• Biofeedback is a therapeutic technique that helps individuals learn how to control their pelvic muscles better. It may be used to address bowel and rectal function.

5. Pessary :
• In some cases, a rectal prolapse pessary, a removable device inserted into the rectum, may be used to provide support and reduce prolapse symptoms.

6. Open/Laparoscopic Rectopexy: A surgical procedure to reposition and secure the rectum.