Surgical treatment of rectal prolapse
Rectal prolapse is the movement of a fragment of the large intestine (rectum) through the anal canal and rectum. There are three main forms of rectal prolapse:
- total prolapse (full wall) - displacement of all layers of the rectal wall through the anus (mucosa, muscles),
- partial prolapse - displacement of a fragment of the rectal mucosa;
- Internal prolapse (hidden, rectal intussusception) - intussusception of one section of the intestine into another, which is not accompanied by the displacement of the rectum outside the anus.
The causes of rectal prolapse are not fully understood.
The causes of prolapse of the rectum in children include chronic constipation and the associated increased effort during defecation. Children suffering from cystic fibrosis are also more susceptible to the disease due to a chronic cough that causes an increase in intra-abdominal pressure.
Rectal mucosal prolapse in adults is often associated with the presence of large rectal varices (hemorrhoids). In the elderly (mainly in older women, who constitute the largest group of patients suffering from rectal prolapse), the factor conducive to the occurrence of the disease may be significant weight loss, which, in combination with weakening of the pelvic and anal muscles, reduces the support for the rectum. In some patients, the presence of symptoms may be related to a history of perinatal trauma.
Chronic constipation and stool output are considered to be the main causes of rectal prolapse in young people. Conditions such as injuries and tumors of the spine and spinal cord, psychiatric disorders, and multiple sclerosis (MS) also contribute to rectal prolapse.
In the initial stage of the disease, prolapse of the rectum is accompanied by defecation. As the discomfort progresses, the symptoms intensify and may accompany situations with increased intra-abdominal pressure, such as sneezing, coughing, and pressure on the stool. In the absence of adequate treatment for the disease, prolapse of the rectum can occur spontaneously, without a cause.
The disease can manifest itself:
- bleeding that is caused by damage to the rectal mucosa
- excretion of increased amounts of mucus,
The patient may experience pain and more frequent urgency than normal. It is not uncommon for you to feel incomplete bowel movement.
Diagnosis of rectal prolapse:
The basic diagnostic method for rectal prolapse is rectal examination. During the examination, decreased anal sphincter tone is found, while rectal prolapse is observed during pressure on the stool. Rectoscopic examination allows the assessment of about 20 cm of the large intestine using a special sight glass. Rectoscopy performed on a patient suffering from rectal prolapse may show the place of intussusception, the presence of inflammation or damage to the mucosa. Colonoscopy (endoscopic examination of the large intestine) is performed in adults qualified for surgical treatment of rectal prolapse to accurately assess the entire large intestine. In some cases, it is advisable to do so. Hinton test, which allows you to assess the speed of intestinal passage. It involves the oral administration of special markers for several days, which are then visualized in a radiological examination.
Differentiation of rectal prolapse:
Symptoms similar to those seen as a result of rectal prolapse may actually be other disease entities. Rectal prolapse is differentiated from:
- large hemorrhoids (varicose veins),
- rectal tumor moving through the anus,
- genital warts,
- abnormal morphology of the perineum,
- polyps in the anus.
Based on clinical symptoms, rectal prolapse should also be differentiated in inflammatory bowel diseases.
Laparoscopic reectexy is performed using a mesh. The advantages of this method are:
- pain reduction
- shortening the hospitalization period
- smaller postoperative wounds
- earlier recovery of colon function and faster recovery of the patient
Rectopexy is the rectification of the rectum, consisting in attaching the rectum to the periosteal surface of the sacrum with single sutures as well as non-absorbable meshes.
Recurrences after rectexy are between 2 and 10%.
Serdecznie zachęcamy do obejrzenia filmu z zabiegu Beskidzkiego Centrum Laparoskopowego z Centrum Leczenia Otyłości, który wykonał zespół dr Michała Dyaczyńskiego.
Reception doctors in the office
PhD in medical sciences
specialist in general surgery
specialist in general surgery