Rectal prolapse occurs when your rectum, the lowest part of your large intestine, prolapses out of your anus. It’s caused by a failure of the muscles and connective tissue that hold it in place. Rectal prolapse is often mistaken for hemorrhoids, but it doesn’t go away on its own and needs surgery to fix it.
Your rectum is the end of the colon or large intestine. “Prolapse” describes any body part that has fallen from its normal position. With rectal prolapse the rectum has lost the attachments that keeps it in place and when there is pressure to move your bowels it comes throughthe anus with the feces and can come outside the body. Some weakening or deterioration is normal with aging, but rectal prolapse is not normal. Childbirth, chronic constipation or diarrhea are major risk factors.
It most commonly affects women after childbirth especially over the age of 50 and is relatively common.
While rectal prolapse is not truly emergent it can cause severe discomfort and lead to the inability to move your bowels, obstructed defecation, or fecal incontinence. Living with it for any length of time can be very difficult.
Failure of the connective tissue and muscles that hold the rectum in place leads to rectal prolapse. There are numerous risks. The most common are:
Rectal prolapse and hemorrhoids can have some similar symptoms, and it can be hard to tell the difference. Hemorrhoids are swollen blood vessels in the anus or rectum. They cause itching, pain or bleeding. Hemorrhoids can also prolapse and they may look similar to rectal prolapse. Both hemorrhoids and rectal prolapse are common after pregnancy, or with chronic constipation or diarrhea. Hemorrhoids are mainly caused by excessive straining and will go away on their own after a week or so. Rectal prolapse is chronic and progressive and associated with much more difficulty passing feces. The symptoms may change, but won’t go away.
Dr. Guerette and the IWI team will review your medical history and perform an exam. Additional tests are usually performed to confirm and determine the extent of the diagnosis:
If you have rectal prolapse it is common to have additional pelvic floor disorders. Dr. Guerette will check for these conditions so that they can be addressed together. Common additional conditions include:
If you’re an adult rectal prolapse won’t improve without surgery.
Untreated rectal prolapse can lead to several possible complications, including:
There are two main surgical approaches to fixing rectal prolapse. From the abdomen to through the anus. Which procedure is best depends on the specifics of your condition but for women who are reasonable surgical candidates an abdominal approach with a rectopexy is the most successful.
This procedure restores your rectum to its original position in your pelvis. The rectum is attached to the sacrum (a ligament over your tailbone) with permanent stitches. This is typically reinforced with mesh. A rectopexy is traditionally done with open surgery (a large incision to access your organs) or laparoscopic surgery, done through small incisions with a camera. Both procedures need general anesthesia.
Robotic Rectopexy: Dr. Guerette is the most experienced robotic pelvic reconstructive surgeon in the region and has developed a robotic rectopexy technique that is significantly less invasive and more successful than standard techniques. With this technique Dr. Guerette uses a graft to re-establish the ligamentous support of the rectum. This a done with specialized “knotless” suture”. A robotic rectopexy with Dr. Guerette has a 97% long-term success rate.
If abdominal surgery isn’t an ideal option for you a trans-rectal approach through your anus is possible. Rectal surgery doesn’t always require general anesthesia as abdominal surgery does. Some people can have it with epidural or spinal anesthesia. The rectal or “perineal” approach may also be a better choice if you have a very minor prolapse. There are two common procedures:
Altemeier procedure. In this procedure, your surgeon pulls the prolapsed rectum out through your anus and removes it. Then the large intestine (your remaining colon and your anus) is put back together
Delorme procedure. If you only have a mucosal prolapse, or a small rectal prolapse, Dr. Guerette may choose a more minor procedure. The Delorme procedure only removes the prolapsed mucosal (inner) lining of your rectum. The tissue is then folded back to the muscle wall of the rectum and stitched in place.
The Intimate Wellness Institute’s team of expert understands how devasting rectal prolapse can be and how difficult and embarrassing it can be to get help. We are here to make you comfortable and get you better. If you are suffering from rectal prolapse contact IWI for a consultation.
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