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BOWEL CONDITIONS

Rectal Prolapse

 

What is rectal prolapse?

Rectal prolapse is a condition in which the rectum becomes stretched out and protrudes out of the anus. The condition can occur in both men and women, but is much more common in women.

Why does rectal prolapse occur?

Several factors may lead to the development of rectal prolapse. It may be related to lifelong constipation with a habit of straining to have bowel movements or a late consequence of childbirth. Occasionally it may run in families. As individuals age, the pelvic ligaments that support the rectum inside the pelvis and the anal sphincter muscles weaken. This allows the rectum to prolapse or protrude out of the anus. Sometimes rectal prolapse may be associated with urinary incontinence, or bladder and uterine prolapse. Neurological problems such as spinal cord injury may also lead to rectal prolapse.

What are symptoms of rectal prolapse?

Individuals with rectal prolapse may experience the feeling of a protrusion from their anus during bowel movements. Occasionally only part of the rectum may protrude and other times a large portion of the rectum or entire rectum may prolapse. This may be associated with leakage of mucous or stool due to weakening of the sphincter muscles.

Rectal prolapse may cause significant embarrassment and frustration for patients. Many patients will live for years with this condition and not mention it to anybody including their physician.

How is rectal prolapse diagnosed?

Sometimes, rectal prolapse may be difficult to diagnose. The condition may be confused with hemorrhoids, which can also prolapse from the anus. However, rectal prolapse involves protrusion of the rectum (the portion of colon just above the anus and hemorrhoids) whereas hemorrhoids originate lower in your anus near the opening.

Colorectal surgeons are trained to diagnose and treat rectal prolapse. After a complete history and physical exam, Dr. Zaghiyan may ask you to demonstrate the prolapse by sitting on a commode and “strain” as if you are having a bowel movement. A picture taken at home demonstrating the prolapse is also useful in making the diagnosis. Sometimes it may be necessary to perform a special x-ray or MRI to diagnose the prolapse or identify other associated conditions in order to best guide your treatment.

How is rectal prolapse treated?

After a diagnosis of rectal prolapse is made, Dr. Zaghiyan will discuss with you the surgical options available. There are several surgical methods to correct rectal prolapse.

Surgery may be approached through the rectum or abdominally. Abdominal surgery can generally be performed through a minimally invasive approach either laparoscopically or by robotic-assisted surgery. The decision to perform rectal or abdominal surgery is based on many factors including your age, overall health and extent of prolapse. If you have associated uterine or bladder prolapse, you may be referred to a specialist who treats these other conditions. A multi-team approach may be necessary to address your condition. Make an appointment today for a thorough evaluation and examination by Dr. Zaghiyan in her office in Los Angeles.

How successful is treatment?

In the majority of individuals symptoms will resolve completely or will be significantly improved. The success of surgery depends on the type of surgery performed, your overall condition, the severity of prolapse, other associated conditions and degree of weakening of your anal sphincter muscles.

If there is weakening of your sphincter muscles they generally regain function over time after the prolapse is corrected. It may take up to a year after prolapse surgery to realize the full impact of the operation on your bowel function. In patients who continue to suffer from seepage of stool and mucous over time, other treatments to address the weak sphincters can be offered after the prolapse is corrected. It is extremely important to avoid constipation and straining after prolapse surgery to reduce the chance of recurrence of prolapse.