What Is Rectal Prolapse?

Partial or full-thickness displacement of the rectal wall is called rectal prolapse. Part of the rectal wall is down, that is, the rectal mucosa is down, which is called a mucosal prolapse or incomplete prolapse; a full-thickness of the rectum wall is called a full prolapse. If the rectal wall moves down in the anorectal cavity, it is called internal prolapse; if it moves down to the outside of the anus, it is called external prolapse. Rectal prolapse occurs in children and middle-aged and elderly women. Rectal prolapse in children is mostly mucosal prolapse, which usually heals before 5 years of age. Complete rectal prolapse is not common in adults. Repeated prolapse of the rectum can lead to anal incontinence due to genital nerve damage and the risk of causing rectal ulcers, bleeding, stenosis and necrosis, which requires surgical treatment.

Basic Information

nickname: Prolapse
English name: rectal prolapse
Visiting department: General surgery

Common causes: Stunting, malnutrition, frailty, constipation, diarrhea, enlarged prostate, chronic cough, etc.
Common symptoms: Prolapse from the anus

Causes of rectal prolapse

The cause of rectal prolapse is not fully understood and is believed to be related to a variety of factors.

Anatomical factors

Stunted infants, malnourished patients, and old and weak people are prone to weak levator ani muscles and pelvic floor fascia; children's sacrums have small curvatures and over-straightness; surgery, trauma and damage to anorectal muscles or nerves can weaken The tissue around the rectum fixes and supports the rectum, and the rectum is prone to prolapse.

2. Increased abdominal pressure

Such as constipation, diarrhea, prostatic hypertrophy, chronic cough, difficulty urinating, multiple deliveries, etc., often cause abdominal pressure to rise, pushing the rectum downward.

3. Other

Internal hemorrhoids and rectal polyps often prolapse, pulling the rectal mucosa downward, inducing mucosal prolapse.

Clinical manifestations of rectal prolapse

The main symptom is prolapse from the anus. The swelling is small in the first episode, prolapses during defecation, and resets itself after defecation. In the future, the mass will gradually come out, and the volume will increase. Afterwards, you will need to support your back to the anus with your hands, accompanied by endless defecation and a feeling of falling. Finally, you can get out when you cough, force or even stand. As prolapse worsens, anal incontinence of varying degrees is caused, and mucus often flows, leading to eczema and itching around the anal skin. Due to difficulty in rectal emptying, constipation often occurs, and the number of stools is increased, showing sheep-like stool. Mucosa is erosive and blood flows out after ulceration.

Symptoms of internal prolapse are not obvious, and are mainly manifested by the symptoms of incomplete defecation, anal obstruction and other rectal emptying disorders. A suppository is inserted into the anus to assist in defecation to smooth the defecation. Some patients have pain in the lower abdomen and lumbosacral region during defecation. Longer course can also cause varying degrees of anal incontinence.

Patients need to hold their breath after squatting to make the rectum prolapse. Partial prolapse shows a round, red, smooth surface with radial mucosal folds; the length of the prolapse generally does not exceed 3 cm; the finger test only touches two layers of folded mucosa; if it is a complete rectal prolapse, the surface mucosa has " "Concentric ring" folds; the prolapse is longer, and the prolapsed part is folded by two layers of intestinal wall, which is thicker on palpation; when the anal canal is not prolapsed, there is a deep circular groove between the anus and the prolapsed intestinal canal.

Rectal prolapse examination

Digital rectal examination

Anal sphincter contraction was felt during digital rectal examination. When the patient contracted forcefully, there was only a slight contraction.

2. Defecation angiography

It is of great value in the diagnosis of rectal prolapse. The funnel sign, sawtooth sign, and pagoda sign are specific signs of rectal prolapse on the defecation contrast radiograph.

3. Anoscopy

The rectal mucosa can be directly observed, which can help distinguish rectal prolapse from ring hemorrhoids and rectal polyps.

Rectal prolapse diagnosis

According to the medical history, let the patient squat down to simulate defecation, make the rectum or rectal mucosa come out of the anus and observe. Generally, the diagnosis can be made. Percussion and double-finger examinations are helpful to distinguish mucosal prolapse and full-thickness prolapse, and fecal angiography can help diagnose internal prolapse. The diagnostic criteria are as follows:

Type I: Incomplete rectal prolapse, that is, rectal mucosal prolapse. The rectal mucosa layer prolapses outside the anus, and the exudate is hemispherical, and the surface of the rectum can be seen with a circular mucosal groove around the rectal cavity.

Type 2: Complete rectal prolapse, that is, full-thickness rectal prolapse. The prolapsed rectum has a conical shape, and the prolapse can be a concentric circular groove arranged in the center of the rectal cavity. Type 2 is divided into three degrees according to the degree of prolapse:

The first degree is the intussusception in the ampulla of the rectum, that is, recessive rectal prolapse. The defecation radiograph was umbrella-shaped.

The second degree was prolapse of the rectum outside the anus, the position of the anal canal was normal, the function of the anal sphincter was normal, and there was no anal incontinence.

The third degree is that the rectum and part of the sigmoid colon and the anal canal prolapse from the anus, and the anal sphincter function is impaired, with anal incompleteness or complete incontinence.

Rectal prolapse treatment

The treatment of rectal prolapse varies according to age and severity, mainly to eliminate the causes of rectal prolapse; infantile rectal prolapse is mainly conservative treatment; adult mucosal prolapse is most often treated with sclerotherapy; adult's complete Rectal prolapse is mainly treated by surgery.

General treatment

To develop a good bowel habit, we should pay attention to shortening the bowel movement time and immediately reset the prolapsed rectum to prevent edema and incarceration. Actively treat diseases such as constipation and cough that cause increased abdominal pressure to avoid exacerbation of prolapse and recurrence after surgical treatment. Anal sphincter function can be performed daily to prevent prolapse.

2. Adhesive tape is legal

For early rectal prolapse in young children. After resetting the vertical intestine, do a digital rectal examination, push the prolapsed intestine over the sphincter, take a prone position, block the anus with a gauze roll, then close the hips and fix with tape.

3. Drug treatment

The sclerosing agent is injected into the submucosa of the prolapse site, or the pelvic rectal space and the posterior rectal space, so that the mucous membrane and the muscular layer, the rectum and the surrounding tissue produce aseptic inflammation, and the adhesion is fixed. Commonly used hardeners are 5% phenolic vegetable oil and 5% quinine urea hydrochloride aqueous solution. It has good effect on children and the elderly, and it is easy for adults to relapse. It is not suitable for patients with degree rectal prolapse.

4. Surgery

There are many surgical methods for complete rectal prolapse in adults, each with advantages and disadvantages and different recurrence rates. There are four surgical approaches: transabdominal, transperineal, transabdominal, and transsacral. The first two approaches are more applied.

Rectal suspension fixation in transabdominal surgery is effective in treating rectal prolapse. After the rectum is freed during surgery, the rectum and sigmoid colon can be fixed on the surrounding tissues by various methods, mainly on the tissues on both sides of the iliac crest. Take care not to damage the peripheral nerves and anterior iliac venous plexus; the pelvic floor muscles can be sutured at the same time Membrane, levator ani muscle, resection of the lengthy sigmoid colon, rectum.

Transperineal surgery is safe, but the recurrence rate is high. The prolapsed rectum and even the sigmoid colon can be directly removed and sutured from the anus. Rectal mucosa prolapse can be removed by hemorrhoidal circumcision. The elderly and weak can simply perform anal ring contraction, that is, use metal wire or polyester tape to surround the anus under the skin, and remove the subcutaneous implants 2 to 3 months later to tighten the anus to prevent rectal prolapse.

5. Laparoscopic surgery

Laparoscopic treatment of rectal prolapse often adopts rectal fixation, which has the advantages of less surgical injury, less pain for patients, rapid postoperative recovery, and fewer complications.