Rectal Prolapse Disease

DESCRIPTION

Protrusion of the rectum through the anus

Partial prolapse - Involves only the mucosa. Frequently follows anal operative procedures. Characterized by radial rectal folds prolapsing through the anus.
Complete prolapse (procidentia) - Involves the entire rectal wall. Most commonly occurs spontaneously in children or as a complication of other disorders in the elderly. Characterized by concentric rectal folds prolapsing through the anus.
System(s) affected: Gastrointestinal
Genetics: Unknown
Incidence/Prevalence in USA:
4.2:1000 overall; 10:1000 after age 65 years
Predominant age: 2 years in children, 60-70 years in adults
Predominant sex: Male > Female (5:1 in adults, and a slight predominance in children)

SIGNS AND SYMPTOMS

Children
- Sensation of anal mass
- Pain
- Rectal bleeding
- Protruding mass
Adults
- Anorectal pain or discomfort during defecation
- Feeling of incomplete evacuation
- Rectal and urinary incontinence
- Rectal bleeding or discharge

CAUSES

Children
- Idiopathic (most common)
- Abnormal innervation of levator ani muscle complex, puborectalis or anal sphincters or abnormal anatomic relationships of these muscle groups
Adults
- Diastasis of levator ani
- Loose endopelvic fascia
- Loss of normal horizontal position of rectum
- Weak anal sphincter

RISK FACTORS

Myelomeningocele
Exstrophy of the bladder
Cystic fibrosis
Chronic constipation or diarrhea
Imperforate anus
Multiple sclerosis
Stroke/paralysis
Dementia

LABORATORY

N/A
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

N/A

IMAGING

Barium enema is useful in selected cases of recurrent rectal prolapse

DIAGNOSTIC PROCEDURES

Sigmoidoscopy is useful in recurrent prolapse to rule out rectal lesions

APPROPRIATE HEALTH CARE

Outpatient, unless complications occur or surgical intervention required

GENERAL MEASURES

Acute
- Prompt manual reduction of prolapse
- Treatment of diarrhea or constipation

SURGICAL MEASURES

Recurrent
- Sub-mucosal injection of 5% phenol in glycerine in four quadrants under general anesthesia (outpatient)
- Linear electrocauterization (inpatient)
- Transabdominal Ripstein's procedure (suspension of rectum from sacrum by means of artificial material)
- Posterior sagittal rectal suspension and levator repair
- Ivalon sponge wrap procedure
- Anterior resection of rectum
- Transabdominal proctopexy (no artificial material used)
- Perineal rectosigmoidectomy
- Thiersch's wire (outpatient procedure; may be modified by using Marlex or Silastic strip instead of wire); used more commonly in children and elderly, poor-risk adults
- Gracilis Sling procedure

ACTIVITY

Full activity, when able

DIET

High fiber

PATIENT EDUCATION

Particular reassurance to parents of infants with prolapse regarding benign nature of problem and high rate of spontaneous resolution
Diet instructions
Teach measures to avoid constipation
Teach family/patient to reduce prolapse

PREVENTION/AVOIDANCE

Avoid constipation and diarrhea

POSSIBLE COMPLICATIONS

Mucosal ulcerations
Necrosis of rectal wall

EXPECTED COURSE AND PROGNOSIS

Spontaneous resolution expected in most children
5-10% recurrence rate for most procedures
Good prognosis with treatment

ASSOCIATED CONDITIONS

Cystic fibrosis
Myelomeningocele
Exstrophy of the bladder
Chronic constipation or diarrhea
Imperforate anus
Paraplegia
Stroke
Incontinence

AGE-RELATED FACTORS

Pediatric: Idiopathic most common type of rectal prolapse in children
Geriatric: Common problem in the elderly
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.