Rectal prolapse
Rectal prolapse: Excerpt from Professional Guide to Diseases (Eighth Edition)
Rectal prolapse is the circumferential protrusion of one or more layers of the mucous membrane through the anus. Prolapse may be complete (with displacement of the anal sphincter or bowel herniation) or partial (mucosal layer). (See Types of rectal prolapse.)
Causes and incidence
Rectal prolapse usually occurs in children younger than age 6 and in adults in their 40s and 70s. It’s commonly associated with other conditions, such as pinworms (enterobiasis), whipworm infection (trichuriasis), cystic fibrosis, malnutrition and malabsorption (such as celiac disease), constipation, and previous trauma to the anus or pelvic area.
True incidence figures are unavailable because many cases go unreported. Females are affected more often than males, accounting for 80% to 90% of reported cases.
Signs and symptoms
In rectal prolapse, protrusion of tissue from the rectum may occur during defecation or walking. Other symptoms include a persistent sensation of rectal fullness, bloody diarrhea, and pain in the lower abdomen due to ulceration. Hemorrhoids or rectal polyps may coexist with a prolapse.
Diagnosis
Typical clinical features and visual examination confirm the diagnosis. In complete prolapse, examination reveals the full thickness of the bowel wall and, possibly, the sphincter muscle protruding and mucosa falling into bulky, concentric folds. In partial prolapse, examination reveals only partially protruding mucosa and a smaller mass of radial mucosal folds. Straining during examination may disclose the full extent of prolapse.
Treatment
In some cases, eliminating the underlying cause is the only treatment necessary. The rectal mucosa can be returned to the rectum manually. While the patient is in a knee-chest position, a soft, warm, wet cloth may be used to apply gentle pressure to the mass to push it back through the anal opening, thereby allowing gravity to help return the prolapse into place. In a child, prolapsed tissue usually diminishes as the child grows. In an older patient, injection of a sclerosing agent to cause a fibrotic reaction fixes the rectum in place. Severe or chronic prolapse requires surgical repair by strengthening or tightening the sphincters with wire or by anterior or rectal resection of prolapsed tissue.
Special considerations
Provide the patient with education regarding underlying causes and preoperative and postoperative support.
❑ Help the patient prevent constipation by teaching her the correct diet and stool-softening regimen. Advise the patient with severe prolapse and incontinence to wear a perineal pad.
❑ Before surgery, explain possible complications, including permanent rectal incontinence.
❑ After surgery, watch for immediate complications (hemorrhage) and later ones (pelvic abscess, fever, pus drainage, pain, rectal stenosis, constipation, or pain on defecation). Teach perineal strengthening exercises: Have the patient lie down, with her back flat on the mattress; then ask her to pull in her abdomen and squeeze while taking a deep breath; or have the patient repeatedly squeeze and relax her buttocks while sitting on a chair.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Rectal prolapse
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Rectal pain (Professional Guide to Signs & Symptoms (Fifth Edition))
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