Rectal Prolapse

Dear Dr. B: Would you do a segment on prolapsed bowel in your “What’s Up Doc” column? The cause, the treatment, and how bad this should be before surgery should be done.

Yes, here is some information about prolapsed bowel – in other words rectal prolapse. If only the lining of the rectum prolapses then it is called incomplete or mucosal prolapse. If the entire wall of the rectum is protruding then it is a complete prolapse or procidentia.

Who gets it?

In children, it occurs most frequently in the first two years of life. Then the incidence declines. It is usually a mucosal prolapse, although occasionally a complete prolapse may be present. Boys are affected little bit more than girls.

There is developmental absence of curvature in the tail bone (sacral curve). The S-shaped rectum loses its curvatures and becomes straight. Thus it is prone to prolapse. Diarrhea, constipation and bad toilet habits can precipitate prolapse.

In adults, complete prolapse is more common than mucosal prolapse. Females are affected (in one series – 84 per cent) more often than males. It most commonly occurs in women 50 years-of-age and over. Quite often these women are in their 80s and 90s.

In a small percentage of women, prolapse of uterus and rectum can occur at the same time.

In younger adults, the prolapse may occur after some sort of rectal surgery. In older adults, the prolapse may occur due to weakness of anal sphincter and tone of muscles in the pelvis supporting the rectum. It is not related to pregnancy and delivery and the number of children a woman delivers. Quite often, prolapse develops in childless women.

Prolapse is like a hernia. The rectum slides in and out of the anal sphincter. Sometimes, it may fail to reduce and gangrene may set in. Urgent hospitalization is required if the prolapse fails to reduce.

How can we treat prolapse of the rectum?

In children, it is a self-limiting condition. Institution of proper bowel habit usually fixes the problem.

In adults, several surgical and non-surgical methods have been described. That means there is no single treatment (especially surgical treatment) which guarantees cure or that it is applicable to all patients.

There are different options for adults who are in good health and are a good surgical risk. Patients with multiple medical problems who are poor surgical risk have limited options.

Two commonly used surgical procedures used for patients who are good surgical risk are:

-removal of most of the rectum and redundant sigmoid colon and joining the colon to the residual small segment of the rectum near the anal sphincter or
-Fixing the rectum in the pelvis with prosthesis like a piece of mesh or sponge.

How bad this should be before surgery should be done?

This depends on how one feels about the problem. And whether the person is a good surgical risk.

If you have a prolapse then you should get a surgical opinion. Like a hernia, it will not go away. It may remain the same or get bigger. And there is a risk of complications, if not treated. This should be weighed against the risk of surgical procedure. Talk to your doctor or surgeon.

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