Rectal prolapse

Rectal prolapse is a condition where the rectum (the last part of the large intestine) protrudes through the anus. It can be partial (mucosal only) or full-thickness (all layers of the rectal wall).

📚 Types of Rectal Prolapse

⚠️ Risk Factors

• Chronic constipation or straining
• Weak pelvic floor muscles (common in elderly and multiparous women)
• Neurological disorders affecting pelvic nerves (e.g., spinal cord injury)
• Previous pelvic surgery
• Cystic fibrosis (in children)
• History of rectal surgery or prolapse

😖 Symptoms

• Visible protrusion of tissue from anus, especially after bowel movements
• Sensation of fullness or incomplete evacuation
• Rectal bleeding or mucus discharge
• Fecal incontinence or mucus leakage
• Constipation or obstructed defecation
• Discomfort or pain during bowel movements

🔍 Diagnosis

• Physical exam (observe prolapse during straining)
• Digital rectal exam
• Defecography or dynamic MRI for detailed assessment
• Rule out other causes like hemorrhoids or anal tumors

💊 Treatment

🔹 Conservative Management

• Stool softeners and laxatives
• Avoidance of straining during defecation
• Pelvic floor exercises (Kegel exercises)
• Treat underlying constipation or diarrhea

🔹 Surgical Treatment

• Indicated for full-thickness prolapse or severe symptoms
• Perineal procedures (less invasive, good for elderly or high-risk patients):
  • Delorme procedure (mucosal resection and plication)
  • Altemeier procedure (perineal rectosigmoidectomy)
• Abdominal procedures (lower recurrence, preferred for younger/fit patients):
  • Rectopexy (fixing rectum to sacrum, with or without sigmoid resection)
  • Laparoscopic or open approach

❗ Complications

• Strangulation or incarceration of prolapsed rectum (rare but surgical emergency)
• Ulceration or bleeding
• Fecal incontinence
• Recurrence after surgery

✅ Summary