What is prolapse?

In medical terms, ‘Prolapse’ is a condition where the organs fall down or move out of their original place. Though prolapse is used to refer to conditions when organs fall through vagina or rectum, it can also refer to the valves that gets misaligned in the heart.  Even a slip disc is referred to prolapse.

Types of Prolapse: (Limiting to Gynecology)

  1. Rectocele
  2. Rectal Prolapse
  3. Cystocele
  4. Uterine Prolapse

If you remember the large intestines and small intestines diagram that you used to draw in school, ‘rectum’ exists at the end of large intestine. This is the organ where feces is stored before being passed out. A condition when this rectum falls through the anus is called ‘Rectal Prolapse’.  This happens when the rectum that is attached to the tissues/muscles gets detached, mostly because of weakening of the tissues. This is usually a rare condition.

Types of rectal prolapse:

  1. Full thickness – The full thickness of the wall of the rectum sticks out through the anus.  This is the most common type of prolapse that shows up. 
  2. Mucosal – Only the lining of the rectum (called mucosa) sticks out of the anus.
  3. Internal – In this condition, the rectum doesn’t actually fall off but it folds on itself inside the body.

What causes rectal prolapse?

A variety of factors can lead to rectal prolapse including:

  1. Pregnancy
  2. Constipation or chronic straining during bowel movement
  3. Diarrhea
  4. Prolapse can also be due to cough when it becomes too much.

Neurological conditions that affect the nerves associated with rectal prolapse include:

  1. Multiple Sclerosis
  2. Lumbar disc disease
  3. Spinal tumors
  4. Injury to the pelvis or the lower back.

Rectal prolapse is most common in adults than children, especially in women aged 50 or above.

Symptoms of rectal prolapse:

During the initial stages, the person may only notice a lump or swelling coming out of his/her anus during passage of stools. The person may be able to push the protrusion back in. However, over time, this protrusion becomes permanent and the person will not be able to push it back in.

As the time passes on, rectal prolapse can happen when standing, coughing or sneezing. Persons having internal prolapse will see nothing coming out of their anus but they may feel that they have not emptied their bowels completely.

Other symptoms of rectal prolapse:

  1. Difficulty controlling bowel movements (due to weak pelvic muscles)
  2. Bright red colour protrusion out of the anus
  3. Discomfort sitting or standing
  4. Constipation.

What happens if rectal prolapse is not treated?

When ignored, rectal prolapse can lead to the following complications and may end up with surgery being performed by your urologist or urogynecologist.

  1. Strangulated prolapse – When a part of the rectum becomes trapped, it cuts off the blood supply, causing the tissues to die. This area turns into dark blue or black colour and drop off.
  2. Solitary rectal ulcer syndrome – Happens in mucosal prolapse where ulcers can develop on the part of the rectum sticking out.
  3. Recurring prolapse – People who have rectal prolapse are likely to experience another prolapse as they age.

Diagnosis of rectal prolapse:

When you present with the symptoms to your urologist or urogynecologist, he/she may examine your bottom. This can include inserting a lubricated, gloved finger into the rectum. Though this sounds very uncomfortable, it is an important step to perform and diagnose.  Apart from physical examination, you may be required to get some tests done such as:

  1. Proctography: This is like an X Ray which shows rectum and Anal canal during a bowel movement.
  2. Colonoscopy: A long, flexible, tube-like camera called a ‘colonoscope’ is inserted into your anus to take a closer look at the large intestine and the rectum
  3. Endo-anal Ultrasound – a thin ultrasound probe to look at the muscles that control the bowels.

(Laser) Treatment for Rectal Prolapse:

The type of treatment depends on various factors including age, type of prolapse, medical problems and constipation problem.

Surgeries to fix rectal prolapse include:

  1. Abdominal – In case of full thickness prolapse, incisions may be made on the abdomen.
  2. Perineal – The full thickness segment of the prolapsing rectum is cut out. 

These surgeries can be performed using conventional tools or advanced Holminu Yag Auriga Laser (or simply Ho Yag Laser). Typically laser surgeries are preferred because of minimal blood loss, quick healing and less pain.