Rectal prolapse is a condition in which walls of the rectum protrude through anus and it becomes visible outside the body. Prolapse of rectum is a common occurrence in elderly people and is rare among children. Human rectum is the part of the large intestine and measures 12-15 cm in length.
Rectum follows the sacrococcygeal curve and is located just above the anal canal. Feces are contained in the sigmoid colon and rectum is usually empty. On the arrival of sensation of fullness the abdominal muscles can be contracted and intra-abdominal pressure increases. Relaxation of pubo-rectal sling and sphincters occurs and muscles of rectum contracts. Then colon and rectum descends and elongation of rectum occurs, feces are discharged and after evacuation the canal is closed by sphincters. In early stage the prolapsed rectum becomes poorly attached but the rectum remains inside the body most of the time.
Only inner lining of rectum protrudes out of the anus. The early stage is known as partial prolapse or mucosal prolapse. Prolapse of inner lining of rectum occurs when connective tissue present within rectal mucosa becomes loose and allows the protrusion of tissues from the anus. After more prolapse of the rectum the ligaments and muscles get weak and large portion of rectum protrudes out through anus. This condition is known as complete prolapse. Rectum may retract initially depending on the activities and movement of patient. But if the rectal prolapse is left untreated, it results in permanent protrusion of rectum. Classification of rectal prolapse
• Partial prolapse:
The lining of the rectum protrudes out of the anus. It occurs after straining during bowel movement.
• Complete prolapse:
The entire wall of the rectum protrudes out of the anus. Initially it may occur during bowel movements. Over time it may occur while standing or walking.
• Internal prolapse: A part of large intestine or rectum may slide over another part, the condition is called intussusception. The rectum does not protrude out of the anus.
Ligaments and muscles that hold the rectum in place when get weak result in prolapse.
Following factors contribute in weakening of ligament sand muscles. :
• Chronic constipation
• Chronic diarrhea
• Straining during defecation
• Increasing age
• Sphincter paralysis
• Whooping cough
• Pregnancy and the stresses of childbirth
• Previous surgery
• Cystic fibrosis
• Chronic obstructive pulmonary disease
• Multiple sclerosis
• Bleeding or mucus discharge from the protruding tissue
• Pain during bowel movements
• Sensation as if something is protruding out from anus.
• Involuntary bowel movements
• Loss of urge to defecate in case of large prolapse
• The feeling as if bowels are not completely evacuated.
• Itching, irritation and pain in anal region.
• Physical examination.
• Barium enema.
• Stool softeners are used to reduce pain and straining during bowel movement.
• Avoid constipation.
• Avoid straining during bowel movement.
• Kegel exercises. Diet should include high fiber content to keep the stool stool to avoid much straining during bowel movement.
• Treating the underlying cause in children have good prognosis.
• Surgery gives relief in symptoms.
• Feels full of small sticks.
• Burning in anus with chills up and down back.
• Mucus seems swollen and obstructs the passage.
• Much pain after stool.
• Constant bearing down in rectum.
• Rectum is sore and hot, relieved by cold water.
• A lot of mucus with pain in rectum after stool.
• Involuntary stool.
• Hard stool with backache and cramping pain in rectum.
• Specially given in prolpase in young children.
• Itching in anus.
• Itching and stitching pain in rectum.
• Painful constriction in anus after stool.
• Pressure as from a sharp instrument from within outward.
• Worse when stool is loose.
• Itching in anal region.
• Prolapse of rectum while urinating.
• Anal region sensitive to touch.
• Very hard stool.
• Stool passes with great difficulty.
• Great weakness after stool.
• Prolapse of rectum with or after stool.
• Constipation alternating with diarrhea.
• Stool passes with much straining.
• Prolapse after stool.
• Prolapse occurs after confinement.
• Rectum protruded while stooping.
• Bleeding with stool.
• Feeling of fullness in rectum.
• Constant oozing from the anus.
• Pain shoots up the rectum and vagina.
• Redness around the anus with itching.
• Painless morning diarrhea, driving patient out of bed with prolapse of rectum.
• Hard. knotty, insufficient stool.
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