Rectal prolapse: symptoms, causes and treatment

The digestive system is one of the most important parts of our bodyBecause through food we can get the energy and nutrients from the external environment that we need for our bodies to function 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 essential for eliminating 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 can appear and lead to complicated or bothersome fecal excretion, or even part of our body protruding. This is what happens with rectal prolapse, Which we will discuss below.

    What is rectal prolapse?

    Rectal prolapse is the medical condition in which the rectum protrudes outside the anus i.e. it slides outward. This protrusion can be partial or complete, coming out of the anus. The last part of the intestine loses the natural anchors that keep it inside the body, causing it to slip. The rectum is inverted, with the lining of the rectum visible from the outside in the form of a red extension in the shape of a finger.

    This problem can be quite uncomfortable for those who suffer from it, as it is common for irritation, pain, or bowel movements to appear. It can also cause symptoms such as diarrhea or constipation, discharge or even faecal incontinence (loss of the ability to control excretion). In addition, the prolapsed rectum can be punctured or ulcerated, causing bleeding that may even require urgent intervention. this issue it can appear at any age and in both sexes. It is particularly common in children under 6 years old, being another type of population in which it is very well known in adults over 50 years old. It tends to be more common in women.

    It is common for this condition to worsen progressively, initially being only the mucosa that protrudes and only in situations of anal effort such as in defecation, returning to its original place soon after. Gradually, however, the rectum is coming out of the body more and more frequently and in more and more situations if it is left untreated. 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.

      Different types or degrees

      Rectal prolapse can appear to varying degrees depending on which parts of the lower third of the intestine protrude. In this sense, we can find different variations.

      1. Partial rectal / mucosal prolapse

      Rectal prolapse in which only part of the lower rectal lining protrudes, with other parts of the rectum or intestine not being affected. It is most common in minors.

      2. Complete rectal prolapse of the first degree

      A type of prolapse in which the entire wall of the anal canal protrudes, make an outer layer of prolapse without containing a peritoneum.

      3. Second degree complete rectal prolapse

      The most common. The anus remains in its usual position, protruding only the rectal mucosa such as the outer wall and the deep part of the peritoneum. In this case, the prolapse it contains an inner part of the small intestine, Having a sac-like cavity.

      4. Complete the third degree or hidden prolapse

      The upper rectum and distal sigmoid invaginate or a landslide is generated from one part of the colon or rectum into another, making the prolapse somewhat hidden and invisible from the outside. This is the least common problem of this type.

      Causes of this problem

      The causes of rectal prolapse can be very diverse, being the direct cause of the loss of subjugation of the lower part of the digestive system. The origin of this loss of attachment is not always entirely clear, but it has been observed that it tends to appear in people who meet certain conditions or undergo situations of considerable effort.

      The possible reasons for this loss of attachment may include malformations, hyperplasia of the colon, or pelvic problems that allow a hernia to appear. It can also appear in situations of continuous straining of the anus or abdomen such as diarrhea or constipation, and even in the face of a chronic cough.

      On another side, its emergence has been observed in women after childbirth. Muscle or nerve problems, infection with worms or cystic fibrosis have also been considered as possible causes of this condition.

      treatment

      Rectal prolapse is a problem that can become serious, but the treatment can vary widely depending on how severe it is with the consultation or the degree and the tissues that are protruding. It should always be a procedure performed by doctors.

      When we are faced with a partial and mild prolapse, the treatment can only be to gently reintroduce the rectum into the anus, usually using a compress to push the paste inwards.

      Sometimes addressing the root causes can solve the problem, at least in children. For example, in case of constipation, laxatives can be applied.

      In adults or in severe cases surgery may be necessary to move and fix the issue 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.

      Bibliographical references:

      • Avendaño, EO (1968). Rectal prolapse. Proctology. 1st edition. Editorial impressions Modernes SA Mexico, DF, p. 138-45.
      • Charúa, L. (2016). Rectal prolapse. [Online]. Available at: http://someal.org/wp-content/uploads/2016/05/PROLAPSO-RECTAL-DR.-CHARUA.pdf
      • Kliegman, RM, Stanton, BF, Saint-Geme, JW and Schor, NF (2016). Surgical conditions of the anus and rectum. A: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Handbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier.

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