Rectal prolapse means complete rectal prolapse where the rectal walls have prolapsed to a degree where they protrude out of the anus and are visible outside the body.
Types
The different types of prolapse are as-Internal prolapse (internal intussusception). A full thickness or a partial rectal wall is affected but the prolapsed tissue does not pass out of the anus.
- External Prolapse- If they protrude from the anus and are visible externally. Full thickness, circumferential, true intussusception of the rectal wall which protrudes from the anus and is visible externally.
- Full-thickness rectal prolapse- A full thickness of the rectal wall protrudes through the anus.
- Mucosal prolapse- Protrusion of only the rectal mucosa (not the entire wall) from the anus.
- Circumferential-Where the whole circumference of the rectal wall prolapse.
- Segmental- Where only parts of the circumference of the rectal wall prolapse.
Grades of Prolapse
- Grade I: Non-relaxation of the sphincter mechanism
- Grade II: Mild intussusception
- Grade III: Moderate intussusception
- Grade IV: Severe intussusception
- Grade V: Rectal prolapsed
Causes
- Pelvic floor dysfunction
- Parasitic infections such as Amoebiasis, schistosomiasis
- Pregnancy
- Cystic fibrosis
- Pertussis (whooping cough)
- Neurologic disorders - Previous lower back or pelvic trauma/lumbar disk disease, cauda equina syndrome, spinal tumors, multiple sclerosis
- Disordered defecation (stool withholding)
- Previous surgery
- Diarrhea
- Benign prostatic hypertrophy
- Chronic obstructive pulmonary disease (COPD)
Symptoms of Rectal Prolapse
History of a protruding mass- Initially, the mass protrudes from the anus only after a bowel movement and usually retracts when the patient stands up. As the disease process progresses, the mass protrudes more often, especially with straining and valsalva maneuvers such as sneezing or coughing.
- Degrees of fecal incontinence which may simply present as a mucous discharge
- Fecal leakage
- A sensation of obstructed defecation (tenesmus)
- Pelvic pain
- A feeling of bearing down
- Rectal bleeding
- Diarrhea
- Constipation(20%-50% of patients) also described as tenesmus (a sensation of incomplete evacuation of stool) and obstructed defecation
- Erratic bowel habits
Treatment
- Laparoscopic procedures
- Perineal procedures
- Perineal rectosigmoidectomy