Rectal prolapse (rectal prolapse)
What is a rectal prolapse?
Rectal prolapse is a rare disease that primarily affects the elderly. The disease is rare in children, affected children are usually younger than 3 years. Men are much less likely to develop rectal prolapse than women (80-90% probability).
The disease affects the rectum, ie the last 12-15 centimeters of the colon just above the anal canal. Normally, the rectum is securely attached to the pelvis by ligaments and muscles. Various factors such as age, long-term constipation or stress during childbirth can weaken this. This causes the rectum to prolapse, ie fall out of its natural body opening (rectal prolapse).
A distinction is a rectal prolapse of a rectocele, which denotes a protuberance of the rectum in the vaginal walls. Another form of rectal prolapse is called intussusception. In this case, one section of the intestine inverts into another, which can cause an intestinal obstruction.
Rectal prolapse is caused by a weakening of the musculature that holds the rectum in place. In most people with a rectal prolapse, the anal sphincter is also weak.
The exact cause of this mitigation is unknown, but risk factors for Rectal prolapse are usually advanced age, prolonged constipation or persistent diarrhea, straining on bowel movements, pregnancy, and birth burden. Rectal prolapse may also be due to previous surgery, cystic fibrosis or chronic diseases.
These include lung diseases, whooping cough, multiple sclerosis and long-lasting hemorrhoidal disease. Children with a rectal prolapse should also be evaluated for cystic fibrosis, as this may be a symptom of this disease.
Symptoms, complaints & signs
Rectal prolapse is manifested by multiple symptoms, with a mild and incomplete prolapse rapidly becoming confused with hemorrhoidal disease. The main symptom of rectal prolapse is the outward-facing and outwardly-obstructed rectum. A distinction is made between a rectal outward-facing rectum and the presence of an intussusception. The latter means an invagination in itself, wherein a collapse of the intestine in itself can also lead to a prolapse.
Since the mucous membranes of the intestine get out, it comes with the sufferers to a permanent feeling of moisture. Sometimes it comes to bleeding, because the leaked rectum is injured by clothing or manual manipulation. A foreign body sensation on the anus is often described by those affected. It often results in itching, which can sometimes be explained by developing inflammation.
A rectal prolapse almost always leads to incontinence. This can lead to the uncontrolled loss of feces or mucus. Incontinence is all the more pronounced, the harder the incident is. A complete rectal prolapse almost always means fecal incontinence. In contrast, a partial prolapse does not necessarily mean fecal incontinence, but it does lead to the onset of mucus. A rectal prolapse is also visually very clearly visible.
Diagnosis & History
In the early stages of rectal prolapse, the rectum gradually dissolves but remains in the body. This stage of rectal prolapse, when the connective tissue of the rectal mucosa loosens and sticks out of the anus, is called mucosal prolapse.
The further the rectum prolapses, the more a part of the rectum presses on the anus and weakens it. This stage is called complete rectal prolapse and is the most common stage of diagnosis of the condition. The symptoms of rectal prolapse are similar to those of hemorrhoids and range from pain on bowel movements, mucus or blood from the protruding tissue to fecal incontinence or loss of urgency.
To diagnose an earlier stage in which the spectrum is not yet protruding from the anus, the physician may administer a phosphate enema to distinguish a rectal prolapse from protruding hemorrhoids. By means of a dynamic MRI, the entire pelvis together with the pelvic floor muscles and pelvic organs can be scanned during bowel movements.
A rectal prolapse or rectal prolapse almost always needs to be treated surgically to avoid complications. Only in children, surgery is usually not necessary. However, older people usually suffer from a rectal prolapse. Due to the progressively increasing weakness of the connective tissue no self-healing takes place here.
When the rectal attack occurs in children, it is usually behind another serious disease, which also promotes the development of complications. Affected children should be screened for, among other things, cystic fibrosis. In the much more frequent cases of rectal prolapse of the elderly, there are always complications over time if the disease remains untreated.
However, life-threatening complications are the exception. A terminal blockage of the rectum usually does not occur because the intestine can be pushed back again and again. However, this can happen in exceptional cases. This is a life-threatening emergency requiring immediate surgical intervention to prevent death of the appropriate rectal segment.
In the other cases, there is no emergency, but surgery is still necessary, because an untreated rectal prolapse leads in the long term next to increasing pain during bowel movements and blood and mucus on the stool also to fecal incontinence. The later the treatment, the more serious are the associated complications. In addition, ulcers can form in the rectum area.
When should you go to the doctor?
An experienced doctor can detect a rectal prolapse at a glance. Rectal prolapse, also known as extended anal prolapse, is often found in older women. He urgently requires a visit to the doctor, because parts of the intestine have leaked through the anal opening.
The precursors of this phenomenon were mostly ignored and triggered by excessive pressing in the toilet. They may not be noticed because often only a few wrinkles of the rectum are advanced. Therefore, the doctor's visit is often omitted with minor complaints. But the rectal prolapse can not go unnoticed as an advanced anal prolapse.
A rectal prolapse can occur even by heavy lifting or a coughing fit. If left untreated, the rectal prolapse will persist for a long time. He needs surgical treatment. In cases of rectal obstruction, a weak pelvic floor or as a result of disease has already leaked larger parts of the rectum and rectum. The consequence of this is that the stool can no longer be held in the intestine. It comes to a gut incontinence.
Even before a rectal incidence occurs, the doctor's visit should be considered. The treatment options are greater the earlier the treatment is started. If there is always the feeling that the anus has become slightly obese after a bowel movement, the visit to the doctor should not be postponed any longer. For prophylaxis, women over 40 should start with pelvic floor training.
Treatment & Therapy
Almost all cases of rectal prolapse require medical care. Occasionally, successful treatment of the underlying cause of rectal prolapse will solve the problem, most often rectal prolapse will worsen without surgery.
In infants and young children, a reduction or dilution of bowel movements under medical supervision can help. Medical treatment is used to temporarily relieve the symptoms of rectal prolapse or to prepare the person for surgery. For this purpose, fillers (bran, psyllium, methylcellulose or psyllium), stool softeners or enemas are used.
The aim of all surgical techniques for correcting a rectal prolapse is to fix the rectum back to the inner pelvis. This procedure under general anesthesia is more likely to be performed through the peritoneal wall in healthy and younger patients, through the perineal in the elderly or in poor health, which generally requires a hospital stay of three to seven days.
A high-fiber diet and the daily adequate supply of fluid can increase the risk of constipation and thus reduce a risk factor for a rectal prolapse. Biofeedback therapies train the pelvic floor muscles and strengthen the sphincter. People with persistent diarrhea, constipation or hemorrhoids should treat these in good time to prevent the risk of rectal prolapse.
The rectal prolapse (rectal prolapse) requires consistent follow-up, regardless of whether it was treated conservatively or surgically. In essence, it is important to avoid the disease recurring or worsening. For this purpose, the gastroenterologist and proctologist, but also the family doctor, the specialist contact. In addition, there are self-help groups for people with proctological illnesses, who can provide a sensitive exchange of experience and helpful tips.
In the aftercare of rectal prolapse or rectal prolapse in particular the chair regulation is very important. Pressure during bowel movements is to be prevented in any case. A (not too) soft and voluminous chair is ideally suited to avoid pressing. Here are fruits and vegetables, especially fiber in the diet.
On a sufficient drinking menu (usually about 1.5 to 2 liters of water or herbal tea) is essential. If this diet is not sufficient for stool control, it is possible to use natural helper with psyllium husks. On stuffing foods such as chocolate or eggs rather a time should be waived.
Exercise is also important for stool regulation. Light endurance sports and walking are recommended in this context. Gymnastics and yoga can also activate bowel movements. Long sitting on the toilet should be avoided as well as active pressing.
You can do that yourself
The rectal prolapse or rectal prolapse is a disease whose diagnosis and therapy belongs in professional hands. Nevertheless, self-help by patients in everyday life is possible and also desirable. The active cooperation of the patient can prevent the rectal prolapse and support both therapy and aftercare purposefully.
The rectal prolapse is in many cases by strong pressing during bowel movements and a weakness of the connective tissue in the area of the pelvic floor. Self-help can be specifically targeted here. It is essential to avoid constipation so that the regulation of the chair plays an important role in the everyday life of the patient. This is achieved by a high-fiber diet in conjunction with a sufficient amount of drinking. Stopping food is best possible to delete from the nutrition plan. Also, a lot of exercise is important because physical activity can stimulate the intestinal activity of those affected and thus can favorably influence a rectal prolapse. Also massage the abdominal area and warm baths with constipation are recommended, as well as psyllium preparations.
The pelvic floor can be well trained by suitable exercises. The exercises are taught by the physiotherapist or the attending physician and can be performed daily at home. Regular visits to the doctor are also important if a rectum attack has been diagnosed and treated. Shame is a major obstacle to discovering an incident (including a recurrence) as soon as possible and having it treated promptly and effectively.