EVALUATION OF PATIENTS WITH PROLAPSEīefore considering surgery, a careful history and physical examination should be done. Rarely, the prolapse becomes stuck or “incarcerated” outside the anus – a situation that could require emergent surgery. Over time, prolapsed rectal mucosa may become thickened and ulcerated causing significant bleeding. It is not unusual for some patients to even note both bouts of constipation and incontinence as well. Constipation associated with prolapse may result from the bunching up of the rectum, creating a blockage that is made worse with straining, generalized coordination problems with the entire pelvic floor, and problems with the ability of the colon to move stool forward at a normal rate. Upwards of 25% to 50% of patients will report constipation.
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The anal sphincter is constantly stretched by the prolapse itself, adding an additional risk factor for incontinence. The pudendal nerve contributes to the control of the anal sphincter and damage can result from direct trauma (birthing injury), chronic diseases such as diabetes, and from back injury or surgery. Pelvic nerve damage (pudendal nerve) has been shown in many patients with prolapse. When the rectum is prolapsed, it has gone past the anal sphincter, and this allows stool and mucus to pass in an uncontrolled fashion. The anal sphincter is a structure made of a number of muscles that allow one to hold on to their stool when they have the urge to move their bowels. Once a prolapse is apparent, fecal incontinence (inability to control gas, liquid or solid BM) occurs in 50-75% of cases and is likely due to a number of factors. Rectal prolapse may be confused with significant hemorrhoid disease and can even be confusing at times to physicians not frequently evaluating and treating this problem. Until the prolapsed rectum goes back in, patients may feel like they are “sitting on a ball”. Patients may later describe a mass or “something falling out” that they may have to push back in following a BM.
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Initially, the prolapse comes down with a bowel movement (BM) and then returns to its normal position. Rectal prolapse tends to present gradually. Some have assumed that the development of rectal prolapse is a consequence of multiple vaginal deliveries however, up to 35% of patients with rectal prolapse have never had children. Chronic constipation (infrequent stools or severe straining) is present in 30-67% of patients, while an additional 15% experience diarrhea. While a number of factors have been shown to be associated with rectal prolapse development, there is no clear cut “cause” of rectal prolapse. In these younger patients, there is higher rate of autism, developmental delay, and psychiatric problems requiring multiple medications.Īlthough an operation is not always needed, the definitive treatment of rectal prolapse requires surgery. Most women with rectal prolapse are in their 60’s, while the few men who develop prolapse are much younger, averaging 40 years of age or less. This condition affects mostly adults, and women over 50 years of age are six times as likely as men to develop rectal prolapse. Overall, rectal prolapse affects relatively few people (2.5 cases/100,000 people). However, it can be quite embarrassing and often has a significant negative impact on patients’ quality of life. While this may be uncomfortable, it rarely results in an emergent medical problem. Rectal prolapse is a condition in which the rectum (the last part of the large intestine before it exits the anus) loses its normal attachments inside the body, allowing it to telescope out through the anus, thereby turning it “inside out”. It will address why surgery may have been recommended, what the various treatment options are, what it involves and how it may help patients. Treatment of this condition may often require surgery, and this patient education material is intended for patients with rectal prolapse who are considering or have been recommended surgery. This information may also be useful to the friends, families, and caregivers of patients dealing with rectal prolapse.
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This patient education piece is designed to help improve patients’ understanding regarding rectal prolapse, specifically its presentation, evaluation and treatment. Print this brochure Rectal Prolapse Expanded Version