The rectum is the last portion of the intestine, located near the anal canal, and is the point where faeces collect before they are expelled. Its walls consist of three different layers: the inner lining (mucosa), a layer of muscle tissue and a layer of fat (mesorectum).Rectal prolapse is defined as the condition in which the rectum tends to slide downwards until it comes out through the anus. We talk about:
- incomplete or mucosal prolapse: in the case where only the mucosa is involved;
- complete prolapse: when the whole rectal wall is involved;
- internal prolapse: in the case where the rectum slides on itself but without protruding from the anal canal.
Rectal prolapse is a disease that normally affects patients at both ends of life, children and the elderly. In the first case, it is a rather rare condition, which occurs in children with particular predispositions (e.g. cystic fibrosis, malnutrition, anatomical changes) and which rarely requires surgical treatment. In the adult, where it occurs most frequently in women, its precise causes are not yet known and we tend to talk instead about contributing factors.
RECTAL PROLAPSE: PREDISPOSING FACTORS AND TRIGGERING CAUSES
The causes of rectal prolapse can be multiple, some genetic and others due to other factors. Among these we can mention:
- genetic predisposition;
- problems concerning the musculature of the pelvic floor;
- neurological diseases (spinal cord injury, myopathies, neuropathies);
- increased abdominal pressure (diarrhoea, constipation, constipation and excessive evacuation efforts);
- parasitic infections;
- late consequence of deliveryo;
- consequences of surgery;
RECTAL PROLAPSE SYMPTOMS
The symptoms vary according to the degree of prolapse advancement and are more and more evident as time passes. Signs and symptoms that occur are:
- presence of mucosa around the anus;
- sliding of the rectum and consequent exit from the anus (occasional at the beginning and constant in the advanced stages of the pathology);
- formation of rectal ulcers;
- abdominal and sacral pain;
- faecal incontinence;
- mucus and blood loss from the anus;
- evacuation difficulties and prolonged effort, up to the need to carry out manual emptying manoeuvres to allow evacuatio;
- constipation and a sense of incomplete emptying;
- sensation of weight in the anal area;
- hypotonia (decrease in the anal sphincter tone).
RECTAL PROLAPSE DIAGNOSIS AND TREATMENT
To define the extent of rectal prolapse, it is essential to carry out a proctological medical examination in which the specialist will analyse the patient’s clinical history through specific examinations. Depending on the severity, the treatment for the treatment of rectal prolapse may be conservative or surgical. The first is a series of measures to be taken when the prolapse is at the beginning, aimed at improving symptoms and causes of the disorder (high-fibre diet, water and laxatives). Surgical treatment involves the use of two different approaches: abdominal or perineal. For each of them, there is a large number of different intervention methods. The most appropriate approach is selected by the surgeon based on the patient’s characteristics (age, gender, symptoms, etc.) and the type of rectal prolapse.
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