Rectal Prolapse

Rectal prolapse is a condition where the rectum protrudes through the anus, often described as a telescoping of the rectum. It is most commonly observed in elderly individuals, particularly females, due to excessive straining during bowel movements. However, younger males with chronic constipation and excessive straining are also at risk.

Symptoms of Rectal Prolapse:

• A noticeable lump or mass protruding through the anus, which may reduce spontaneously or require manual reduction.
• Passage of mucus through the anus.
• Poor control of bowel motions (fecal incontinence).
• Less commonly, rectal bleeding (PR bleeding)
• A sensation of constipation or incomplete evacuation
• Significant pain if the prolapsed segment becomes irreducible and ischemic.‍‍

Diagnosis:

A thorough medical history often provides a strong indication of rectal prolapse. Physical examination, particularly visual confirmation of the protruding rectum, confirms the diagnosis.
If sphincter dysfunction is suspected, additional testing such as anal manometry may help identify underlying issues.

Treatment:

The main goal of treatment is to address contributing factors, particularly toileting habits, and reduce excessive straining.

Conservative Measures:

• Use of bulking laxatives to manage incomplete prolapse and prevent excessive straining.

Surgical Options:

Surgery is necessary for full - thickness rectal prolapse and may include:

1. Laparoscopic/ Robotic Surgery (Keyhole Approach):
   • Elevation and fixation of the rectum to its original position.
   • In cases where constipation is a major factor, partial resection of the colon may be required.
2. Perianal Surgical Treatments:
   • Denuding the mucosa of the rectum and plicating (folding and tightening) the rectal muscle to address the prolapse.