What is rectal prolapse?
In the case of rectal prolapse, the rectum bulges out of the anus. The prolapse can be triggered by a bowel movement, but can also occur spontaneously. The rectal prolapse often slides back into position on its own. In some cases, it can be repositioned in the correct place by hand. If this is not successful, the prolapse is operated on. Rectal prolapse is more common in older people, especially women.
The sooner a rectal prolapse is recognized and treated, the better the chances of recovery. Early detection also minimizes potential risks. Rectal prolapse is rarely life-threatening. However, it severely restricts the quality of life of those affected.
What types of rectal prolapse are there?
Doctors distinguish between two types of rectal prolapse:
- Internal rectal prolapse: Internal prolapse, also known as intussusception, is a cylindrical invagination of the mucous membrane of the upper rectal segments into the rectal opening without exiting the anus. An internal prolapse leads to constipation and liquid, fatty, possibly bloody stools.
- External rectal prolapse: In external prolapse, all layers of the bowel protrude from the anus.
What is the difference between anal prolapse and rectal prolapse?
Rectal prolapse often occurs in combination with anal prolapse. In the case of rectal prolapse, the wall of the rectum pushes itself completely out of the anus. It can protrude eight to ten centimeters outwards. In the case of anal prolapse, only the inner skin of the anus protrudes outwards.
Prolapse of the rectum (rectal prolapse): Causes and risk factors
Rectal prolapse is one of the most common diseases of the rectum in people over the age of 50. Weak pelvic floor muscles play a central role in the disease. The disease affects women much more frequently because their pelvic floor is generally more stressed by pregnancy and childbirth than the pelvic floor of men. More than eight out of ten patients are women. However, rectal prolapse can have other causes. The main causes of rectal prolapse are
Rectal prolapse can also be a symptom of another disease. It should therefore always be treated by a doctor, as it does not heal on its own. The following factors increase the risk of rectal prolapse:
- Congenital malformations
- Gynecological procedures (e.g. removal of the uterus)
- Infections
- Neurological damage to the nerves in the pelvis
- Tumors
- Injuries to the sphincter muscle
Weak pelvic floor muscles as a risk factor
It is completely normal for our pelvic floor muscles to lose stability over time. Heavy births, hard physical labor, chronic coughing and an unhealthy lifestyle all take their toll on our pelvic floor. Even younger women often suffer from weak pelvic floor muscles, for example if they have given birth to several children within a relatively short period of time. Overstretching the muscles during childbirth or a perineal tear permanently weakens the pelvic floor muscles. This can lead to rectal prolapse.
Chronic constipation as a risk factor
Chronic constipation and high defecation pressure can also promote rectal prolapse. If the muscles of the pelvic floor are too weak, the rectum protrudes from the anus due to the permanently increased pressure.
Cystic fibrosis as a risk factor
Rectal and anal prolapse is very rare in healthy children.
The situation is different for children with cystic fibrosis. Some of them struggle with voluminous bowel movements and constipation. This explains why rectal prolapse is more common in patients with cystic fibrosis than in healthy people.
Symptoms: Rectal prolapse (rectal prolapse)
In the early stages of the disease, those affected by internal rectal prolapse initially feel a sensation of pressure in the pelvic floor. It also makes it more difficult to empty the bowel. There is often a tendency to constipation and a smearing of the stool and even the inability to hold a bowel movement. Patients report only being able to defecate by applying manual pressure to the vagina. Sometimes parts of the bowel protrude from the anus. Pain can also occur in the area of the anus. Chronic constipation can also lead to a prolapse of the pelvic floor, a protrusion towards the vagina (rectocele) and hemorrhoids.
Over time, permanent bowel incontinence can develop. Rectal prolapses are often overlooked in the early stages, as they only occur when the patient pushes harder.
These symptoms may indicate a rectal prolapse:
- Possible itching
- Defecation disorder
- Strong feeling of pressure or foreign body sensation at the anus
- Mucus secretion
- Bleeding of the mucous membrane
- Feeling of not being “finished” after defecation
- Increasing anal continence restriction
- Chronic constipation
Rectal prolapse – when to see a doctor?
Many sufferers only go to the doctor when a rectal prolapse has occurred. But the longer you wait with the treatment, the more severe the symptoms become. An incident should be treated in good time. Consult a doctor if you experience any of the above symptoms.
Prolapse of the rectum (rectal prolapse): Diagnosis with us
The causes of rectal prolapse cannot always be determined. In most cases, the doctor can diagnose an acute rectal prolapse simply by looking at it. Otherwise, a prolapse can be caused by pressing. Various tests are available for further clarification:
Blood tests and other examinations may be necessary to examine the patient’s state of health and to better assess the risk of surgery. Before an operation, an endoscopic examination of the entire colon is usually performed.
Staging of rectal prolapse
- Grade I: invisible, internal invagination (intussusception),
- Grade II: visible prolapse with spontaneous reduction,
- Grade III: visible prolapse, manual reduction necessary,
- Grade IV: Reduction not possible.
Rectal prolapse (rectal prolapse): Prevention, early detection, prognosis
Depending on the cause, you can specifically prevent rectal prolapse.
Pelvic floor training – tips for everyday life
- You can avoid straining during bowel movements by ensuring good digestion. It is helpful to eat a varied diet rich in fiber and to drink enough. This promotes softer stools and avoids excessive straining.
- Get your bowels moving with exercise. Exercise also helps with constipation.
- Strengthen your pelvic floor with targeted pelvic floor training. You can also train your pelvic floor in everyday life. At every suitable opportunity, tense the muscles in the pelvic floor as if you wanted to hold a bowel movement or interrupt the flow of urine.
- Women should consistently train their pelvic floor during pregnancy and in the postpartum period.
- Cough and sneeze in a pelvic floor-friendly manner. This is because coughing and sneezing increase the pressure in the abdomen, especially when we bend forward with our upper body. You can simply reduce the pressure by looking up or over your shoulder when coughing or sneezing.
- It is less stressful for the pelvic floor if you bend your knees when lifting and lift objects with the strength of your legs. Keep objects as close to your body as possible when carrying them. And don’t forget to breathe.
Course and prognosis
Rectal prolapse usually means that those affected can no longer empty their bowels completely. It is therefore important to have the incident treated professionally. The chances of recovery after a rectal prolapse are considered good. It does not make sense to help yourself by pushing the bowel back into the anus. This is because rectal prolapse weakens the sphincter muscle in the long term. As a result, fecal incontinence can develop, in which unintentional stool is passed. The most sensible option for rectal prolapse is surgery. Patients can present themselves at the hospital and choose the best procedure together with the surgeon.
Treatment of rectal prolapse (rectal prolapse)
As a rule, rectal prolapses are operated on. Surgery is usually not necessary for children. In this case, consistent treatment of the underlying disease (e.g. cystic fibrosis) is sufficient.
Various minimally invasive procedures are available for rectal prolapse surgery. The choice of surgical procedure depends on various factors, such as the patient’s general condition, age, concomitant diseases and continence status. Nutritional therapies to regulate bowel movements can also be considered. The standard operations for high-grade rectal prolapse are as follows:
- Operation via laparoscopy with fixation of the rectum with a mesh or suture. This procedure can be combined with the removal of part of the bowel.
- Operation via the anus according to Rehn-Delorme or Altemeier.
Details of the treatments
