Rectal prolapse: symptoms, causes and treatment
The digestive system is one of the most important parts of our body , because through food we can obtain energy and nutrients from the external environment we need to keep our body functioning and survive.
But the digestive system has not only an entry point but also an exit point: the rectum and the anus. These elements, which in addition to the digestive system are part of the excretory system, are fundamental in order to eliminate organic waste produced by the functioning of our body and the remains of food that our body is not able to use.
However, sometimes diseases, disorders or alterations may appear that cause the excretion of feces to be complicated or annoying, or even that a part of our organism protrudes. It's what happens with rectal prolapse , which we are going to talk about next.
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What is a rectal prolapse?
Rectal prolapse is the medical condition in which the rectum protrudes outside the anus, that is, it slides outward. This protrusion can be partial or complete, reaching out of the anus. The final part of the intestine loses the natural anchors that cause it to remain inside the body, which causes the sliding. The rectum is reversed, with the mucous lining of the rectum visible from the outside in the form of a red extension, shaped like a finger.
This problem can be quite uncomfortable for those who suffer it, as it is common for irritations, pain or defecatory problems to appear. It can also generate symptoms such as diarrhea or constipation, secretions or even fecal incontinence (losing the ability to control excretion). Likewise, the prolapsed rectum may become perforated or ulcerated, generating hemorrhages that may even require urgent intervention. This problem can appear at any age and in any of the sexes . It is especially frequent in children under 6 years old, being another type of population in which it is highly known in adults over 50 years of age. It tends to be more frequent in women.
It is common that this condition progressively worse, initially only the mucosa that protrudes and only in situations of anal exertion such as defecation, returning to its original place shortly after. However, little by little the rectum is being left out of the body more frequently and in more and more situations if it is not treated. In the case of women, it is possible that the protrusion of the rectum is directed towards the posterior wall of the vagina, being able to generate the condition known as rectocele .
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Different types or grades
Rectal prolapse may appear in different degrees depending on which parts of the lower third of the intestine protrude . In this sense we can find different variants.
1. Partial / mucosal rectal prolapse
Rectal prolapse in which only a part of the lower rectal mucosa protrudes, not affecting other parts of the rectum or bowel. It is the most common in minors.
2. Complete first-degree rectal prolapse
Type of prolapse in which the entire wall of the anal canal protrudes, making the outer layer of the prolapse without containing peritoneum .
3. Full second degree rectal prolapse
The most common. The anus remains in its usual position, protruding only the rectal mucosa as the outer wall and the deep part of the peritoneum. In this case the prolapse contains part of the small intestine inside , having a cavity in the form of a sac.
4. Complete prolapse of third degree or occult
The superior rectus and the distal sigmoid invaginate or a sliding of one part of the colon or rectum is generated within another, making the prolapse something hidden and not visible from the outside. It is the least frequent of this type of problem.
Causes of this problem
The causes of a rectal prolapse can be very diverse, being the direct cause the loss of the subjection of the lower part of the digestive system . The origin of this loss of subjection is not always completely clear, but it has been observed that it tends to appear in people who meet certain conditions or perform situations of considerable effort.
Among the possible reasons for this loss of support may be malformations, hyperplasia of the colon or pelvic problems that allow the appearance of a hernia. It can also appear in situations of continued exertion of the anus or abdomen as in diarrhea or constipation, and even in chronic coughs.
On the other hand, it has been observed its emergence in women after childbirth . Also, muscular or nervous problems, infections by earthworms or cystic fibrosis have been considered also possible causes of this condition.
Treatment
Rectal prolapse is a problem that can become serious, but whose treatment can vary greatly depending on the severity with which it reaches consultation or the degree and tissues that protrude. It should always be a procedure carried out by doctors.
When we are facing a partial and mild prolapse, the treatment can only be to reintroduce the rectum gently into the anus, usually with the help of a compress to push the mass inwards .
Sometimes the treatment of the causes can solve the problem, at least in children. For example, in cases of constipation, laxatives may be applied.
In adults or in serious cases Surgical intervention may be necessary to reposition and fix the matter of the digestive system and the muscles that hold them in place. This surgery can be abdominal or perineal, there are different types of intervention. However, this type of intervention has its risks.
Bibliographic references:
- Avendaño, E.O. (1968). Rectal prolapse. Proctology 1st Edition. Editorial Impresiones Modernas S.A. Mexico, D. F., pp. 138-45.
- Charúa, L. (2016). Rectal prolapse. [On-line]. Available at: //someal.org/wp-content/uploads/2016/05/PROLAPSO-RECTAL-DR.-CHARUA.pdf
- Kliegman, R.M., Stanton, B.F., St.Geme, J.W. & Schor, N.F. (2016). Surgical conditions of the anus and rectum. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier.
