The digestive system is made up of a set of organs that allow the absorption of nutrients and elimination of substances and waste materials, the rectum and anus being the last portions of this excretory system.

The rectal prolapse is off the mucosa or rectal tissue through the anal orifice, secondary to lack of anchorage or correct support of the body. This condition affects all ages, including children and causes discomfort for the patient, especially in individuals in adulthood, being more frequent in the female gender. In fact, it is estimated that after age 50, rectal prolapse affects women on average 6 times more often than men.

The rectal prolapse can only affect the mucosa of the rectum (surface layer of the fabric more) or all of the rectum wall, this latter condition being known as a rectal prolapse.

This pathology is related to other conditions of the digestive system (such as constipation, irritable bowel syndrome, etc.), so when diagnosed, a correct exploration of the entire gastrointestinal system must be carried out and specify if there is any underlying cause to the appearance of rectal prolapse .

Causes of rectal prolapse

The causes of rectal prolapse are numerous. Epidemiological studies have shown that most patients have a history of chronic constipation and due to constant pushing, the rectal mucosa protrudes or exits through the anus. However, other studies affirm that at least 15% of patients have a history of acute or chronic diarrhea.

Another of the causes described in rectal prolapse related to straining are chronic cough and vaginal delivery, due to increased intra-abdominal pressure and straining that directly impacts the perianal region. However, specifically about childbirth, there are some studies that indicate that 40% of women with rectal prolapse did not deliver through the vaginal canal.

On the other hand, there are also causes inherent to the anatomy of the rectum, such as weakness or hypotonia of the sphincter muscles of the anus, weakness of the perianal muscles and an elongated or enlarged colon.

In children, in addition to straining and weakness of the rectal anatomy, congenital collagen and intestinal diseases, such as Ehlers-Danlos syndrome and Hischsprung’s disease, respectively, must be ruled out. In addition to other secondary causes such as trauma.

How does a rectal prolapse occur?

The anal sphincter normally prevents the contents of the intestine and rectal mucosa from exteriorizing or protruding, even during the evacuation process. When a condition occurs in which there is increased intra-abdominal pressure, such as pushing, the intestine pushes its contents towards the natural orifices (such as the navel producing an umbilical hernia or the rectum producing a prolapse).

If added to this context there is an anatomical condition such as weakness of the anal sphincter or of the perianal muscles, then the mucosa or the entire wall of the anus will exit more easily.

You may also be interested in reading information about anal fissure and what its symptoms may be.

Rectal prolapse symptoms

The symptoms of rectal prolapse are varied, predominantly discomfort or a sensation of weight in the anal region. If you present any of these symptoms, it should be suspected in the presence of rectal prolapse :

  • Sensation of mass or weight in the rectal area (rectal protrusion), especially when performing maneuvers that increase the pressure of the abdomen or perineum, such as pushing, coughing, exerting. Sometimes rectal prolapse can be so severe that it can be made worse by walking or just standing.
  • Palpable and visible mass of red or violet color.
  • Rectal incontinence (discharge of fecal contents without control of the anal sphincter).
  • Presence of blood when evacuating , known by the medical term of rectorrhagia.
  • Presence of mucus in stool or in intimate clothing.
  • The rectal prolapse is usually painless, but pain can occur in severe cases.

If you have any of these symptoms, it is important to see a doctor. The doctor specializing in the diagnosis and management of rectal prolapse is the coloproctologist.

How is rectal prolapse diagnosed?

The doctor will carry out a thorough evaluation based on the questioning of the patient, asking the personal and gynecological history in the case of the woman.

The physical examination of the anal region is essential to make the differential diagnosis between hemorrhoids and perianal abscess, for example. The doctor will also consider carrying out other complementary studies such as videodefecogram (radiographic study of intestinal and muscle movements during defecation) and rectal manometry (study that evaluates the functions of the anal sphincter muscles).

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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