What tests should be done for rectal prolapse?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 01, 2024
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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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Written by Deng Heng
Colorectal Surgery
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Clinical manifestations of rectal prolapse

The main symptom of rectal prolapse is a swelling that protrudes from the anus. In the early stages, the swelling is small and only protrudes during defecation, retracting on its own afterwards. As the condition progresses, the protrusion occurs more frequently and grows larger, requiring manual assistance to push it back into the anus after defecation. This is accompanied by a feeling of incomplete bowel evacuation and a feeling of heaviness. If not addressed promptly, the prolapsed intestine may become swollen, constricted, incarcerated, and even risk necrosis. As the prolapse worsens, it can cause varying degrees of anal incontinence, accompanied by the discharge of mucus, which leads to eczema and itching around the anal area.

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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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Written by Chen Tian Jing
Colorectal Surgery
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What is the pathogenic mechanism of rectal prolapse?

The pathogenic mechanism of rectal prolapse primarily refers to the relaxation and sagging of the rectal mucosa down to the anal area, forming an internal rectal mucosa prolapse. Excessive relaxation of the rectal mucosa can protrude externally through the anus in a cylindrical or conical shape, commonly known as external rectal mucosa prolapse or rectal prolapse. The causes are mainly due to congenital deficiency of kidney energy in patients or excessive relaxation of the rectal mucosa due to multiple childbirths. Some patients with long-term constipation may also experience rectal mucosal relaxation due to excessive straining during bowel movements. Additionally, elderly and frail patients may experience sagging of the rectal mucosa as they age.

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Why won't rectal prolapse heal?

The causes of rectal prolapse are complex, and they are not fully understood at present. It is considered to be related to multiple factors: The first factor is anatomical, where underdeveloped or malnourished children, or weak elderly individuals are prone to having weak and powerless levator ani muscles and thin pelvic fascia. Other anatomical issues include a less curved or overly straight sacrum in children, surgical trauma, or damage to the muscles and nerves around the anus. The second factor is increased abdominal pressure, such as from constipation, diarrhea, prostate enlargement, chronic cough, or difficulty urinating, all of which can heighten abdominal pressure and exacerbate rectal prolapse. The third factor is diseases around the anus, such as internal hemorrhoids and rectal polyps that frequently protrude, pulling down the rectal mucosa and easily inducing rectal prolapse. Therefore, its causes are complex, and so is its recovery.

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Can you do yoga with rectal prolapse?

Patients with rectal prolapse can engage in moderate exercise, but it is not recommended to perform exercises that involve significant abdominal strength or squatting movements. This is because excessive abdominal pressure or overexertion can increase intra-abdominal pressure, compressing the mucosa and tissue around the anus, thereby worsening the prolapse. If squatting exercises are performed over a long period, it could further aggravate the degree of rectal mucosal prolapse. Hence, patients with rectal prolapse may opt for gentler exercises like yoga, ensuring that the movements and methods do not exacerbate the condition of the rectal mucosa. Patients with rectal prolapse should seek surgical treatment as soon as possible, where the prolapsed mucosa is completely excised for recovery.