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Rectal Prolapse and Hemorrhoids
Definition of Rectal Prolapse
A rectal prolapse is the partial or complete collapse of the rectum, which sometimes causes it to exit the body.
Symptoms of anal or Rectal Prolapse
The scariest rectal prolapse symptom is when the rectum, part of the lower intestine, falls out of the anal opening.
With rectal prolapse, the rectum can fail to come out at all, only appear with bowel movements or sneezing, or chronically protrude from the body at all times.
The symptoms of internal intussception rectal prolapse are a feeling of fullness, bloating, or internal discomfort, as the rectum slides out of its appointed position and falls against other internal organs.
With rectal prolapse, extreme pain and difficulties with bowel movements may also be noticed, especially if the rectum undergoes any torsion (twisting) during its collapse in any form of the rectal prolapse.
Other forms of rectal prolapse cause the protrusion of some or all of the rectum from the anal sphincter.
Other symptoms of rectal prolapse include bleeding or mucus discharge from the damaged tissue, loss of urge to defecate, and fecal incontinence.
Rectal prolapse that is protruding, will most likely look like a pink sock in both size and color.
Causes of Rectal Prolapse
The anal sphincter is actually a relatively weak group of muscles, and it's insufficient to hold the anorectal canal in place alone, so the canal is usually supported by a series of girdling muscles and ligaments.
Rectal prolapse is caused by the progressive weakening of those muscles and ligaments, releasing the rectum to slide downwards with gravity.
This muscular weakening is associated with:
Advancing age, which is therefore a cause of rectal prolapse.
Prolonged straining during bowel movements due to constipation or diarrhea can weaken the muscles thereby causing rectal prolapse.
Pregnancy and the stresses of childbirth can weaken the muscles causing rectal prolapse to occur.
Previous surgery can also weaken the muscles and cause rectal prolapse.
Cystic fibrosis, COPD, multiple sclerosis, paralysis, or any chronic condition or activity that necessitates frequent exploration or invasion of the anorectal canal, may lead to muscle weakness and resulting rectal prolapse.
Finally, the anal opening was not designed by evolution for sexual penetration, so anal sex, being an activity involving the invasion of the anorectal canal, can cause the muscles to give way, thereby leading to rectal prolapse.
Types of Rectal Prolapse
There are three different kinds of rectal prolapse, starting with internal intussuception which is where the rectum collapses but does not exit the rectum or protrude from the anus. In this instance, it may fall against other internal organs causing discomfort, a feeling of pressure, or bloating.
The second variety of rectal prolapse is the prolapse of the rectal mucosa without the accompanying muscle wall behind it. The mucosa itself is rather thin, and may also be prone to tearing and damage during this sort of prolapse.
The third and most serious kind of rectal prolapse is full thickness, and describes the collapse and protrusion of the entire rectum from the anal sphincter.
Differentiating between Rectal Prolapse and Hemorrhoids / Hemroids / Piles
In contrast to a hemorrhoid, rectal prolapse most closely resembles a pink sock turned inside out instead of a much smaller lump of mucus tissue.
In addition, rectal prolapse follows a slightly different progression pattern, starting with protrusion only during bowel movements, up through protrusion during sneezes or other abdominal contractions, onward to protrusion during activities like walking and eventually chronic protrusion where either the hemorrhoid or the rectum fails to retract at all.
In contrast, prolapsed hemorrhoids start out by protruding and retracting on their own during bowel movements followed by retracting only when pushed back in by a finger and finally to always protruding from the anal sphincter no matter how many times it's pushed back in.
You can also find several pictures of hemorrhoids here.
For non-surgical treatment of hemorrhoids, you can use medicinal ingredients in tablet, cream or lotion form.
Rectal Prolapse Treatment for Children, Pregnancy and following Childbirth
If the rectal prolapse is due to pregnancy, stresses of childbirth, or occurs in children, the rectal prolapse is often self correcting, so a period of medication and observation will generally be tried before suggesting surgery.
In children, the muscles and ligaments may not have developed enough yet for some reason, causing the rectal prolapse. The rectal prolapse will usually get better as the child grows.
In the case of pregnancy and childbirth, hormones are released during pregnancy that cause all ligaments and joints to get looser in preparation for the pelvic stretching that birth requires. This loosening may lead to rectal prolapse in and of itself or in combination with the rapidly changing weight demands that pregnancy also entails, and such rectal prolapses will probably self correct as the female body returns to normal after birth.
Rectal Prolapse Surgery
Many rectal prolapses can only be treated by surgery.
While there are medications that go along with that rectal prolapse surgery, they only perform as a support mechanism and cannot replace the need for a surgical procedure. These medications tend to be stool softeners or fibrous bulk agents and they serve to reduce the amount of straining necessary to defecate, which hopefully gives the rectal canal some much needed rest.
Two basic types of rectal prolapse surgery
There are two basic types of surgery for rectal prolapse, abdominal and perineal.
Abdominal Rectal Prolapse Surgery
Abdominal surgery for rectal prolapse covers all of those surgical procedures that start by incising into the abdominal wall to get to the area in question while the patient is under general anesthesia.
This type of rectal prolapse surgery is more traumatic to the body, and therefore more dangerous, but it is also more effective as it allows the surgeon full access to the area to repair any muscle walls or ligaments that may have stretched or broken.
Perineal Rectal Prolapse Surgery
Perineal rectal prolapse surgery goes in near the anal sphincter, and is much less traumatic to the body as a whole due to both the smaller incision and the fact that it can be done under local anesthesia.
However, because of the smaller incision and the different angle of surgery, it is also less effective over the long term in fixing rectal prolapses.
Abdominal or Perineal Rectal Prolapse Surgery?
Therefore, for rectal prolapses, abdominal surgery tends to be reserved for younger patients, while perineal surgery tends to be performed on older patients or those who have other conditions that render them less able to endure the trauma that abdominal surgery creates or who cannot tolerate general anesthesia.
In both varieties, however, the goal is to fix the mechanical problem with the supporting muscles and ligaments to return the rectal canal to its proper place within the body.
If you're too weak for surgery of any kind, a doctor may insert a wire or plastic loop to hold the anal sphincter closed and prevent further rectal prolapse, but this is a stopgap procedure at best.
Recovery phase, precautions, restrictions, time off work, following rectal prolapse surgery
Surgery for rectal prolapse is not a pleasant prospect no matter what kind you're going in for.
Abdominal rectal prolapse surgery will probably involve a hospital stay of three to seven days, while perineal surgery has a much shorter hospital stay of two to three days.
You'll need plenty of emotional support from friends and family both before and after the procedure, and you'll probably need a fair bit of physical support afterwards as well.
You may be under dietary restrictions both before and after the surgery, and you need to obey those in order to have the best possible outcome.
In addition, you may be under significant restrictions regarding activities and especially lifting any kind of weight.
You may have an anti-inflammatory prescribed prior to rectal prolapse surgery in order to reduce the chances of swelling during the procedure, and you'll probably be prescribed antibiotics and painkillers for after the surgery in order to make you more comfortable and to eliminate any chance of infection.
Choosing a doctor for your surgery
Remember, if you are uncomfortable with a doctor for any reason, you need to find a new doctor. No doctor has the right to make you feel inferior or to treat your concerns carelessly.
In addition, any doctor ought to be perfectly willing to tell you how many times he or she has done your particular procedure successfully.
However, once you find a doctor you trust, be sure to follow his or her instructions to the letter.
Long term side effects and prognosis following rectal prolapse surgery
The prognosis after surgery varies wildly, depending on a number of factors.
Incontinence or infection are both potentially severe side effects of any surgery in this area.
In addition, constipation is a fairly frequent side effect which may or may not clear up on its own after surgery.
The chances of recurrence of rectal prolapse are quite low for patients who have undergone abdominal surgery, but exist for both abdominal and perineal procedures.
By following all pre- and post- surgical directions, eating a diet rich in fiber, getting plenty of fluids, and taking bulk fiber or stool softeners as needed after surgery, you should be able to recover fully and once again enjoy a normal quality of life.
Research and main write by Loni L. Ice, editing and additional writing by D. S. Urquhart.
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