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Description
Rectal prolapse describes a condition in which all or part of the rectum protrudes outside the anus.
Cause and risk factors
This condition is found in very young children, and in the elderly, and is associated with
- worm infestations (pinworm, whipworm, ascaris)
- constipation and straining at stool
- congenital abnormalities - such as meningomyelocoele
- cystic fibrosis
- severe diarrhea
- straining to pass urine - children with severe phimosis
- malnutrition
- rectal polyps
- pelvic floor muscle weakness - old age, surgical damage
- sexual abuse with anal penetration
Diagnosis
In cases where the rectum has spontaneously returned to its normal position, the account by the child’s mother, or the adult patient, of a wrinkled red mass appearing during straining at stool is enough to make a clinical diagnosis.
For those cases in which the rectum has not returned to its normal position, the diagnosis is obvious.
Further examination may reveal a possible cause for the prolapse, such as malnutrition, scars of previous surgery.
Treatment and complications
The immediate treatment in all cases is to try to replace the visible rectum. This is done with the patient in the knee-chest position, with the doctor using lubricated gauze pads to gently coax the rectum back into place. A pressure dressing is then applied, and the buttocks may even be taped together for a few hours to ensure that the position of the rectum is retained. In most cases, this is successful.
If this fails, or if the prolapse recurs, surgery is indicated - this may be done as an emergency if manual reduction fails, and if the prolapse has endured for some time. If surgery is not done quickly enough, long-term complications can arise, such as incontinence, bleeding or even gangrene of the trapped bowel. There are various techniques available, but they all basically tether the rectum to surrounding tissues, to ensure that it remains in position.
Any underlying contributory causes, such as chronic constipation, must be treated, to help prevent recurrence.
Outcome
Treating the underlying problem can often cure the problem. Those patients with recurrent prolapse generally do well after surgery, especially if anatomic problems contributing to the prolapse are repaired at the same time, such as tightening slack pelvis muscles.
