Rectal prolapse is a condition in which the rectum (the lower end of the colon, located just above the anus) becomes stretched out and protrudes out of the anus. Weakness of the anal sphincter muscle is often associated with rectal prolapse at this stage, resulting in leakage of stool or mucus. While the condition occurs in both sexes, it is much more common in women than men.
Types of Rectal Prolapse
There are two types of rectal prolapse: 1. Partial thickness prolapse and 2. Full-thickness prolapse.
1. Partial-Thickness Rectal Prolapse
Partial thickness rectal prolapse, is where the lining of the rectum (mucosa) becomes loose and falls downs into the lumen of the anal canal when straining. Because it is not full thickness, it rarely prolapses enough to protrude through the anus. Partial thickness prolapse may cause some degree of blockage in the rectum when straining (obstructive defecation), and may be a contributing factor to constipation.
2. Full-Thickness Rectal Prolapse
Full thickness rectal prolapse is where the entire wall of the rectum becomes so loose that on straining it telescopes on itself to such an extent that it falls out being visible external to the anus. Full thickness rectal prolapse is often mistaken for a haemorrhoid.
A physician can often diagnose this condition with a careful history and a complete anorectal examination. To demonstrate the prolapse, patients may be asked to sit on a commode and “strain” as if having a bowel movement.
Occasionally, a rectal prolapse may be “hidden” or internal, making the diagnosis more difficult. In this situation, an x-ray examination called a videodefecogram may be helpful. This examination, which takes x-ray pictures while the patient is having a bowel movement, can also assist the physician in determining whether surgery may be beneficial and which operation may be appropriate. Anorectal manometry may also be used to evaluate the function of the muscles around the rectum as they relate to having a bowel movement.
Although constipation and straining may contribute to the development of rectal prolapse, simply correcting these problems may not improve the prolapse once it has developed. There are many different ways to surgically correct rectal prolapse.
Abdominal or rectal surgery may be suggested. An abdominal repair may be approached laparoscopically in selected patients. The decision to recommend an abdominal or rectal surgery takes into account many factors, including age, physical condition, extent of prolapse and the results of various tests.
A great majority of patients are completely relieved of symptoms, or are significantly helped, by the appropriate procedure. Success depends on many factors, including the status of a patient’s anal sphincter muscle before surgery, whether the prolapse is internal or external, the overall condition of the patient. If the anal sphincter muscles have been weakened, either because of the rectal prolapse or for some other reason, they have the potential to regain strength after the rectal prolapse has been corrected. It may take up to a year to determine the ultimate impact of the surgery on bowel function. Chronic constipation and straining after surgical correction should be avoided.
Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions if indicated to do so.
The LBSG procedure takes between 40 minutes to1 hour.
The procedure requires one night stay in the hospital after the operation.
After surgery, the patient must follow special diets and vitamin intake to lose weight in a controlled manner.