Rectal (or anal) prolapse corresponds to externalization of the rectum which can lead to constipation or fecal incontinence. It affects women 9 times more than men.
What is the definition of rectal or anal prolapse?
Experts speak of prolapse whenan organ slips from its normal position in the body. “In the case of rectal prolapse, the rectum turns in such a way that the rectal mucosa is visible externally of the body in the form of a finger-shaped projection of the anus, moist and dark red in color”, explains Dr Monique Quillard, general practitioner. Rectal prolapse is a pathology that mainly affects the elderly, but also young children and infants.
Is it more common in women?
Women are most often affected because they are more sensitive to constipation problems. Menopause is also a risk factor. Rectal prolapse affects women 9 times more than men.
What are the stages of rectal prolapse?
The stage depends on the extent of the prolapse and the level of discomfort caused. “Anatomically the “turned” part can remain internal, we then speak of grade 1, or it can be externalized, it is then grade 2“, specifies Dr. Quillard.
→ Grade 1: the returned part remains internal
→ Grade 2: the returned part is external
What are the causes of anal prolapse?
The causes of anal prolapse are numerous:
- aging of tissues,
- weakness of the pelvic floor due to pushing efforts,
- chronic constipation
- pelvic floor muscle weakness linked to a sedentary lifestyle.
- In women after menopause, pelvic floor weakness may be due to hormonal decline,
- after traumatic deliveries (episiotomy or not).
Rectal prolapse is sometimes accompanied by prolapse of the bladder (cystocele) or the uterus (hysterocele): this is then a “organ descent“.
What are the symptoms of anal prolapse?
The symptom of rectal prolapse is exteriorization of part of the rectum during defecation. Some associated signs are possible:
- blockage of stools and constipation,
- a feeling of discomfort (but no pain)
- sometimes, fecal incontinence.
What tests are needed to diagnose anal prolapse?
The diagnosis of rectal prolapse is easy to make. L’physical examination is enough: the doctor can observe the presence of an exteriorized red mucous membrane at the level of the anal verge, an accentuated protrusion a few centimeters long, during thrusting, or the perception of an anomaly during rectal examination. This examination is completed by questioning (gynecological history, constipation, stool status, fecal incontinence, etc.). “More rarely a dynamic MRI can be carried out to clarify the diagnosis and choose the appropriate surgical treatment. Other examinations are performed much more rarely: defecography, anal manometry, colonography, urodynamic assessment, cystoscopy.“, explains our expert.
What is the treatment for rectal prolapse?
Rectal prolapse in children does not cause any particular complications. “You simply need to teach him to avoid excessive pushing when potty training, because they can cause hemorrhoids and anal fissures which are painful and promote constipation.“, specifies Dr. Quillard. In case of constipation, a suitable diet (rich in fruits, vegetables, legumes and whole grains for their fiber intake) with sufficient hydration is necessary. Sometimes, a laxative may be prescribed to facilitate defecation. In adults, the same recommendations apply in cases of constipation. Techniques to strengthen the pelvic muscles are sometimes carried out with the help of a physiotherapist. Surgery is considered if the prolapse is too severe.
When to consider the operation?
There are two types of surgical intervention:
► The first interventioncalled rectopexyconsists of raising the rectum and fixing it on the sacrum (pelvic bone) to using synthetic strips. This procedure is most often carried out by laparoscopy using 4 small incisions without large opening of the stomach. This intervention lasts 1 hour. It is carried out under general anesthesia.
► The second intervention consists of achieving removal of the rectal sausage exiting through the anus passing through the natural channels, that is to say through the anus. It can be done under regional anesthesia, without general anesthesia. However, it gives less good results than rectopexy, the risks of recurrence are greater at 5 years. It is offered to patients whose general condition does not allow them to benefit from general anesthesia.. This procedure is shorter and lasts 30 to 45 minutes. An enema is performed before the procedure. The operation is covered by Social Security.
You will be able to eat the same evening as the procedure. A mild laxative treatment will be systematically prescribed in order to avoid the effort of flare-ups.
Thanks to Dr Monique Quillard, general practitioner