Rectal Prolapse
Definition
Rectal prolapse is protrusion of rectal tissue through the anus to the exterior of the body. The rectum is the final section of the large intestine.
Description
Rectal prolapse can be either partial or complete. In partial prolapse, only the mucosa layer (mucous membrane) of the rectum extends outside the body. The projection is generally 0.75–1.5 in (2–4 cm) long. In complete prolapse, called procidentia, the full thickness of the rectum protrudes for up to 4.5 in (12 cm).
Rectal prolapse is most common in people over age 60, and occurs much more frequently in women than in men. It is also more common in psychiatric patients. Prolapse can occur in normal infants, where it is usually transient. In children it is often an early sign of cystic fibrosis or is due to neurological or anatomical abnormalities.
Although rectal prolapse in adults may initially reduce spontaneously after bowel movements, it eventually becomes permanent. Adults who have had prior rectal or vaginal surgery, who have chronic constipation, regularly depend on laxatives,have multiple sclerosis or other neurologic diseases, stroke, or paralysis are more likely to experience rectal prolapse.
Causes and symptoms
Rectal prolapse in adults is caused by a weakening of the sphincter muscle or ligaments that hold the rectum in place. Weakening can occur because of aging, disease, or in rare cases, surgical trauma. Prolapse is brought on by straining to have bowel movements, chronic laxative use, or severe diarrhea.
Symptoms of rectal prolapse include discharge of mucus or blood, pain during bowel movements, and inability to control bowel movements (fecal incontinence). Patients may also feel the mass of tissue protruding from the anus. With large prolapses, the patient may lose the normal urge to have a bowel movement.
Diagnosis
Prolapse is initially diagnosed by taking a patient history and giving a rectal examination while the patient is in a squatting position. It is confirmed by sigmoidoscopy (inspection of the colon with a viewing instrument called a endoscope) Barium enema x rays and other tests are done to rule out neurologic (nerve) disorders or disease as the primary cause of prolapse.
