By melbourne@colorectal/November 12, 2024
Rectal Prolapse
Rectal prolapse is a condition that involves the rectum turning inside out on itself and coming out through the anus. Full-thickness rectal prolapse involves the whole wall of the bowel turning inside out on itself, partial thickness involves the inner lining only.
Symptoms:
The prolapse produces an uncomfortable lump through which is red-purple. The lump may spontaneously reduce. The prolapse also causes bleeding with mucus and symptoms of incontinence.
Cause:
There are various anatomical features that may predispose: Deep anterior pelvic cul de sac, redundant sigmoid colon, diastasis of the levator ani. Rectal prolapse occurs mainly in females the peak incidence is in the 6th to 7th decade.
Investigations:
- Bedside examination including sigmoidoscopy can diagnose the condition. Examination with the person straining on the commode can diagnose it.
- Colonoscopy: usually performed in the elderly to exclude other problems.
- Examination under anaesthetic: may be needed to diagnose the problem.
- Anorectal Physiology and USS: Often used to record sphincter muscle status especially if incontinence is a major symptom.
Treatment:
In children with rectal prolapse procedures to avoid straining and holding the prolapse back in may cure the problem.
In adults with full-thickness prolapse surgery is generally required.
Over 100 different operations have been described to treat rectal prolapse.
Transabdominal Procedures:
Rectopexy alone or resection rectopexy both of which can be done laparoscopically or open.
Laparoscopic Ventral Rectopexy is a procedure now being offerred which uses a mesh placed between rectum and vagina sutured to these structures then fixed to pre-sacral tissues. This has a high success rate and is tolerated well in the elderly population. The operation avoids post-operative constipation which has been a problem in some other surgeries.
Perineal Procedures:
The Delorme procedure which is a mucosal resection and re-anastomosis, and the Altemeier or rectosigmoidectomy are the 2 commonest procedures.
Improvement in incontinence can be expected in 50% of cases.
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