Last section of the large bowel is called rectum. Rectal prolapse is the condition where rectum protrude out the anus when the supporting tissues are weakened. It severely disrupts quality of life with gas and stool incontinence, bowel obstruction, excess strain during defecation, constant wetness and flow complaints in the anus. Generally seen in advanced age women with multiple deliveries. These patients are frequently accompanied by other prolapsed organs like bladder. Most of the patients have constipation and excess strain history for many years. In addition, 30% of the patients are male or female patients who never have given birth.
As rectal prolapse complaints are similar to hemorrhoids, such patients are often diagnosed and treated for hemarrhoidal diseases. The part protruded out from the anus in internal hemorrhoids disease is actually the internal hemorrhoids packs from small intestine layers. Almost all patients say that intestine or a mass protrudes out of the anus after defecation and that they put it back by pushing with their hands. Therefore, it is very important to examine the patients with these complaints by having them strain in order to perform a good differential diagnosis.
Internal Hemorrhoids Disease
There are different rectal prolapse types that changes the complaints and severity of these complaints
1. Full layer prolapse:
As can be seen in the figure, rectum is protruded out of the anus like a telescope together with all layers of the bowel.
2. Mucosal prolapse:
As can be seen in the figure, only the mucosa of the rectum is prolapsed.
3. Internal intussusception:
Internal rectal prolapse, or intussusception, is defined as a full thickness prolapse of the rectum that does not protrude through the anus. This is the most difficult type to diagnose as there is no intestine segment that protrudes out the anus. Patients often feel a blockage when they are defecating, and they say that they strain excessively. Depending on this excess strain, patients may develop hemorrhoidal disease. Another complaint is mucous discharge after defecation and stained underwear. Radiologic imaging is the most successful way to diagnose patients with these complaints after a good examination. The diagnosis of intussusception can be made easily with the examination of the defecography.
HOW RECTAL PROLAPSE IS TREATED ?
The only treatment of rectal prolapse is surgical treatment. There are different surgical techniques, whether abdominal or anal, used to repair prolapsed structure. The treatment method is determined by evaluating the patient’s age, general condition, presence of additional diseases, type of prolapse and results of radiological tests. Aim of the surgery is rectopexy or removal of the prolapsed intestine segment.
1. Abdominal repair:
In recent years, Laparoscopic Ventral Mesh Rectopexy became a standard treatment with its successful results. This is the best option for the patients with rectocele (vaginal herniation) and intussusception together with rectal prolapse.In this operation, 3 or 4 small punctures are opened for laparoscopy and the rectum is hanged up (rectopexy) with the use of a synthetic patch (mesh).In female patients, such mesh can also be placed between vagina and rectum, therefore treating the rectocele as well. In this operation, uterus and bladder prolapse, which often accompany rectal prolapse in female patients, can also be simultaneously repaired.
2. Anal repair:
a.STARR (Stapler Transanal Rectal Resection):
Excess and prolapsed rectum mucosa is removed by inserting a surgical tool called stapler into the anus.This technique is suitable only for patients with mucosal prolapse or rectal intussusception.
b. Perineal Resection:
Rectum segment that protrudes out the anus is resected and removed.Bowel is anastomosed to the anus. This method is preferred for patients with high anesthesia risk, elderly patients and patients with accompanying diseases.