18 March 2019 The rectum is the portion of the digestive tract between the colon and the anus. A prolapse can be external or internal ; that is, it may or may not come extend through the anus. When this exteriorisation takes place, it may involve only part of the rectal wall or the entire rectal circumference - in this case, the rectal prolapse is complete. In the early stages, exteriorisation may not be permanent . However it tends to remain over time. Rectal prolapse occurs in both sexes, but in adults it particularly affects women aged over 60 . It is not related to the number of times the woman has given birth. In children, temporary rectal prolapse , resulting from straining associated with defecation, is common. What are the causes of rectal prolapse? Various factors may be at the root of or contribute to rectal prolapse , and it is often difficult to distinguish a single cause. These can include: Continued straining when defecating; Some degree of genetic predisposition; Pelvic trauma; Certain neurological problems. The problem also appears to be related to: The normal ageing process; Weakening of the muscles and ligaments supporting the rectum; Loss of the capacity of anal sphincter muscles to contract; Faecal incontinence. In children , rectal prolapse is usually associated with: Parasitic infections; Insufficient diet; Nutrient absorption deficits; Constipation; Trauma to the anal or pelvic region. What are the symptoms of rectal prolapse? The most obvious symptom is the exteriorisation of the rectal wall , which is visible as a section of moist red tissue (rectal mucosa). In some cases, there may be rectal bleeding. Faecal incontinence is common. Rectal prolapse is unpleasant, but is not usually painful. How is rectal prolapse diagnosed? Diagnosis is made on the basis of: Clinical history; Symptoms; Examination of the patient. The examination is carried out by placing the patient in various positions and contracting the muscles of the abdominal wall or the anal sphincters, to simulate the act of defecating . This makes it possible to determine the extent of the prolapse. A digital rectal examination or manometry may help to determine the muscle functionality of the anal sphincters. Where the rectal prolapse is not externally visible, an X-ray examination known as a defecography may be indicated. This will help to: Confirm the existence of prolapse; Determine the need for surgical intervention; Select the most appropriate approach to take if surgery is necessary. In some circumstances, especially when an underlying medical condition is to be identified, other tests such as flexible sigmoidoscopy or barium enema may be indicated. What is the treatment for rectal prolapse? In children and young people , by identifying and eliminating the causes of straining during defecation, conservative treatment is usually opted for. Squeezing the buttocks together between evacuation of faeces, together with some physiotherapy exercises, may help to solve the problem. However, for adults , the simple act of correcting problems of constipation and staining when defecating does not, as a general rule, lead to resolution of the prolapse. Therefore, surgical treatment is often required. Surgical treatment There are various ways of surgically correcting a rectal prolapse. Typically, the operation involves repositioning and fixing the rectum at the appropriate site and/or removing a section of the organ. The operation may be carried out: Through the perineum; Through the abdomen. Intervention via the abdomen , although more invasive , is the most effective method, and is associated with a lower rate of relapse . The problems inherent to using the abdominal route are solved by the use of laparoscopic surgery , since this intervention can (and, where possible, should) be carried out by laparoscopy. The decision as to the most appropriate approach depends on a number of different factors , including: Age; Extent of the prolapse; General condition of the person; Results of the various pre-operative examinations carried out. Successful intervention also depends on a number of factors, in particular: General condition of the person; Functionality of the anal sphincters; Extent of the prolapse; Surgical technique adopted. As a general rule, once surgical treatment has been performed on the rectal prolapse, most patients experience a complete cure or significant improvement. Are there any post-surgery preventive measures? After the operation, to help prevent recurrence of the condition, measures should be taken to make defecation easier , such as: Increased intake of fibrous food; Increased intake of non-alcoholic liquids, especially water. Colorectal surgery is carried out by gastroenterologists and general surgeons. This article was written with the support of physicians and other clinical professionals from the Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
