Rectal Prolapse


Introduction

Rectal prolapse is when the last part of the intestine (rectum) comes out through the anus. The amount of intestine sticking out of the anus depends on the severity of the disease. It can range from a lesion of a few centimetres long, sometimes mistaken for haemorrhoids, to extreme cases where the entire rectum may remain outside the anus. Prolapse can cause faecal incontinence, bleeding, or pain. If it is incomplete or internal it can make bowel movement difficult, with the sensation of anal plug.

The causes of this pathology can be: chronic constipation, weakness of the perineum muscles due to the stress of vaginal delivery, especially in case of difficult deliveries; or physiological ageing of the support structures of the pelvic floor as well as neurological lesions.


Treatment

Rectal prolapse is only treated with surgery. The prolapsed correction may be carried out through the abdomen with laparoscopic surgery or with open surgery. The laparoscopic surgery is called ventral rectal sacropexy and consists of separating the rectum from the vagina, stretching it upwards and attaching it to the upper part of the sacrum by applying a reinforcing mesh. Open surgery is performed through an incision above the pubis (such as for a Caesarean delivery) and consists of cutting off the redundant colon, moving the back of the rectum and attaching it to the sacrum at a higher level. In this case, the reinforcement mesh is not used.

In other cases, surgery can be performed from the anus using two types of techniques. In the case of small prolapses, rectal mucosa is removed and sutured into the rectum musculature so as to return to its normal position. In the case of large ones, it is preferable the transanal rectal sigmoidectomy technique, which consists of drying the entire wall of the rectum from the anus and sometimes the final part of the colon (if it has also descended), by suturing the healthy part to the anus itself.


Benefits

After the prolapse surgical correction, the patient will no longer suffer from bowel coming out through the anus, and symptoms of pain and bleeding when sitting will go away. In many cases, the added problem of faecal incontinence will disappear. In the case of incomplete or internal rectal prolapse, the patient will recover the ability of having regular bowel movements without difficulty, and symptoms of pain, weight or pressure in the pelvis or the anus will disappear. It also improves other problems secondary to defecatory straining due to prolapse, such as haemorrhoids and fissures.




Expert opinion

Dr. Domenico Fraccalvieri
Dr.  Domenico Fraccalvieri

If the treatment is performed by surgeons with specific experience in pelvic floor pathology, rectal prolapse surgery is a treatment with low risk of complications and high degree of satisfaction for the patient. It is more frequent in elderly women although it is also possible in young people due to a problem of tissue hyperlaxity or to childbirth; while in male is possible but rare. When prolapses are complete and external, they cause bleeding, pain, and faecal incontinence. If they are incomplete, internal or occult they cause problems of occupation, pain, and problems with bowel movements despite laxatives; and are usually confused with a generic constipation disorder.


Patients who notice significant difficulty in having a bowel movement, a feeling of occupation or anal plugging and even try instinctively to remove the stool with the finger or by pressing around the anus, should be evaluated by a specialist to rule out an occult rectal prolapse.

Curriculum


Accreditations Main