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Rectal Prolapse

WHAT IS RECTAL PROLAPSE?

Rectal prolapse is a condition in which the rectum (the lower end of the colon, located just above the anus) turns itself inside out.  The bowel protrudes form the anal canal after defeacation in severe cases stays out permanently.  Weakness of the anal sphincter muscle is often associated with rectal prolapse at this stage and may result in incontinence (leakage of stool or mucus.)  This condition can occur in both sexes, although it is more common in women than men.

WHY DOES IT OCCUR?

Several factors may contribute to the development of rectal prolapse.  It may come from a lifelong habit of straining to have bowel movements or as a delayed result of stresses involved in childbirth.  In rare cases, there may be a genetic predisposition in some families.

It seems to be a part of the aging process in many patients who experience weakening of the ligaments that support the rectum inside the pelvis as well as loss of tightness of the anal sphincter muscle. In some cases, neurological problems, such as spinal cord transection or spinal cord disease, can lead to prolapse.  In most cases, however, no single cause can be identified.

IS RECTAL PROLAPSE THE SAME AS HEAMORRHOIDS?

Some of the symptoms may be the same. There may be bleeding and/or tissue that protrude from the rectum.  Rectal prolapse, however, involves a segment of the bowel located higher up within the body, while haemorrhoids {link} develop near the anal opening.

HOW IS RECTAL PROLAPSE DIAGNOSED?

A prolapse of the rectum may be obvious on initial examination.

However, a rectal prolapse may be "hidden" or internal.  In this situation additional special tests may be needed.  An x-ray examination called a defecating proctogram may be helpful. This examination, takes x-ray pictures while the patient is having a bowel movement.

Anorectal manometry may also be used.  This test measures whether or not the sphincter muscles around the anus are working normally.

HOW IS RECTAL PROLAPSE TREATED?

Although constipation and straining may be causes of rectal prolapse, simply correcting these problems do not improve the prolapse once it has developed.  There are many different ways to surgically correct rectal prolapse.  There continues to be debate as to which method is the best.

Abdominal, laparoscopic or perineal bottom end surgery may be suggested.  A detailed discussion taking into account patient age, fitness and main symptoms is needed to decide which option is likely to be the best for each individual patient.

HOW SUCCESSFUL IS TREATMENT?

Success depends on a number of factors, including the status of a patient's anal sphincter muscles before surgery.

If the anal muscle has been weakened either because of the rectal prolapse or for some other reason, it may in many cases significantly regain strength after the rectal prolapse has been corrected.

Chronic constipation and straining after surgical correction must be avoided and additional laxative medication may be needed.  Large proportions of patients are relieved of symptoms, or are significantly helped, by the appropriate procedure.  However there are patients who do get recurrence despite the best efforts of an experienced colorectal surgeon.

If you wish to arrange an appointment with Dr. Rob Church at Al Zahra Hospital Dubai

Contact Al Zahra Call Center on +971 4-378-6666