How to check for rectal prolapse?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 19, 2024
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Rectal prolapse is generally divided into internal rectal mucosal prolapse and external prolapse, also known as rectal procidentia. If it is an internal prolapse, an anoscopy combined with defecography is required to examine the degree of laxity of the local rectal mucosa. If it is an external prolapse or rectal procidentia, the patient generally presents with a prolapsed swelling when squatting, and this can be further evaluated with a digital rectal examination to assess the local tightness of the anus. If rectal prolapse occurs, surgical treatment is recommended as it tends to be quite effective. In cases of pediatric prolapse or mild prolapse, traditional Chinese medicine enemas may be used to alleviate local symptoms.

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Written by Chen Tian Jing
Colorectal Surgery
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What tests should be done for rectal prolapse?

Rectal prolapse primarily refers to excessive laxity of the rectal mucosa within the anal canal. This lax mucosa accumulates at the anal opening, forming a clinical symptom. Patients may experience significant local swelling and a feeling of falling down. In severe cases or when the prolapse overly obstructs the anal opening, it might lead to difficulties in defecation and constipation. To diagnose rectal prolapse, an initial assessment typically involves a digital rectal examination and an anoscopy to simply and initially screen for the presence of mucosal prolapse. Further, a defecography might be required to ascertain the severity of the rectal prolapse. For mild rectal prolapse, topical medications can be used to alleviate symptoms. In cases of moderate or severe rectal prolapse, surgery is necessary to excise the lax mucosal loop.

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Colorectal Surgery
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Rectal prolapse treatment

Rectal prolapse is primarily categorized into mild rectal prolapse as well as moderate and severe rectal prolapse. Mild rectal prolapse generally occurs in the early stages of the illness or in children and can be treated conservatively. Conservative treatment mainly involves Chinese herbal retention enemas. On the other hand, moderate and severe rectal prolapse can result in the protrusion of the local mucosa outside the anus, presenting as cylindrical or cone-shaped prolapses. Treating moderate to severe hemorrhoidal prolapse requires surgical intervention. The main surgical methods include hemorrhoidal mucosectomy with stapling and local submucosal sclerosant injections. It is also important to caution postoperative patients against squatting for long periods or straining during constipation, as these actions can exacerbate symptoms of submucosal prolapse.

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Colorectal Surgery
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Causes of rectal prolapse

The causes of rectal prolapse primarily include older age or physical weakness leading to relaxation and sagging of the pelvic and rectal mucosa. Prolonged constipation can also lead to excessive straining during bowel movements, causing stress-induced sagging of the intestinal mucosa. Additionally, women who have gone through childbirth may experience rectal prolapse due to excessive straining of the pelvic floor muscles during delivery or increased abdominal pressure during pregnancy, which compresses the rectal mucosa. The treatment for rectal prolapse mainly consists of conservative medication or surgical removal. For mild cases of rectal prolapse, including those in children, traditional Chinese medicine enemas can be used. However, for moderate to severe cases, or cases where prolapse recurs frequently and significantly forms a complete prolapse, surgical removal is recommended.

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Colorectal Surgery
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Clinical manifestations of rectal prolapse

The clinical manifestations of rectal prolapse mainly involve the contents within the anal canal, especially the prolapse of the rectal mucosa outside the anus, which is most common. Severe cases of rectal prolapse may lead to a cylindrical or conical prolapse. The common type of rectal prolapse mainly refers to rectal prolapse, but there can also be internal prolapse of the rectal mucosa. Internal prolapse of the rectal mucosa is characterized by excessive relaxation and accumulation of the rectal mucosa at the anus, causing symptoms such as a sense of blockage, downward pressure, and obstruction during bowel movements. This can be definitively diagnosed through an anal examination and defecography. Regardless of whether it is internal prolapse of the rectal mucosa or rectal prolapse, when the disease progresses to a severe degree affecting the patient's normal life, surgical treatment is recommended.

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Can you get pregnant with rectal prolapse?

Patients with rectal prolapse can become pregnant, but if diagnosed with rectal prolapse before pregnancy, it is advisable to first surgically remove the prolapsed mucosa. This is because during pregnancy, as the fetus grows, the pressure in the abdominal cavity gradually increases. Female patients may experience worsening of the rectal prolapse due to increased abdominal pressure, which could lead to increased congestion and edema, thereby exacerbating the severity of existing hemorrhoids or the severity of the rectal prolapse. Therefore, if there are symptoms of rectal prolapse before pregnancy, surgical treatment is recommended. If rectal prolapse occurs during pregnancy, conservative treatment with traditional Chinese medicine enemas can be chosen, and surgery can be considered after childbirth.