Prolapsed rectum
Risk Factors
Definition
Partial: Lining of the rectum slides out of place and usually sticks out of the anus. Can occur with straining during bowel movements. Common in children younger than 2 years
Complete: The entire wall of the rectum slides out of place and usually sticks out of the anus. May occur only during bowel movements at first, but over time occur with standing or walking. In some cases, may remain outside all the time.
Internal (Intussception): Part of the wall of colon may slide into or over another part. Does not protrude from the anus. More common in children than adults. Cause unknown
Complications
Straining during bowel movements
Tissue damage caused by surgery or childbirth
Weakness of pelvic floor muscles that occur naturally with age
Symptoms and presentation
Fecal incontinence
Leakage of blood or mucus from the anus
Feeling of full bowels
Passage of many very small stools
Feeling of incomplete emptying of bowels
Anal pain, itching, irritation, bleeding
Bright red tissue protruding from anus
Treatments
Push prolapse into place
Avoid constipation
Drink fluids
Eat fibre-containing foods
Kegel exercises to strengthen pelvic floor
Avoid straining
Surgery: re-attachment of the muscles of the pelvic floor or sacrum and/or removing part of the intestine that is no longer supported by the surrounding tissue.
Psychosocial: Embarrassment, negative impact on quality of life
Affects women more than men (6:1)
Gradual presentation, initially may come down with bowel movements then return to normal position. Patients may later describe a mass or "something falling out." May be confused with significant hemorrhoid disease.
Diagnosis: Colonoscopy to rule out polyps, cancer, hemorrhoids
Urinary incontinence (35%)
Prolapse of other pelvic structures (e.g. into vagina)
Defecography if diagnosis in doubt (X-ray with contrast during BM)
Possible ERAS post-op
Skin breakdown due to incontinence