Prolapse

Overview

Rectal prolapse occurs when the rectum protrudes through the anal opening due to stretching or disruption of its attachments to the abdominal wall.

What are the causes of prolapse?

The exact cause is unknown. Predisposing factors, on the other hand, include:

• Prolonged bowel movement straining,
• Multiple pregnancies
• neurological illnesses that cause muscle weakness, or connective tissue disorders
• Rectal prolapse is frequently associated with anal sphincter muscle weakness, resulting in stool leakage and mucus discharge. The elderly are more likely to suffer from this condition.

Treatment options available for prolapse:

The treatment of prolapse is determined by the history of symptoms as well as a physical examination. Defecography is required in the case of an internal rectal prolapse. In some cases of minor, early prolapse, treatment can be started at home by using stool softeners and manually pushing the fallen tissue back into the anus. Prolapse can be repaired surgically in a variety of ways. The laparoscopic surgeon will decide whether to perform surgery based on the patient's age, other existing health problems, the extent of the prolapse, the results of the examination and other tests, and his experience with specific techniques.

It includes three distinct methods, each of which is used depending on the nature of the prolapse.

1. Perineal approaches to rectal prolapse

MIPH (Minimally Invasive Procedure for Hemorrhoids): This procedure is only used in cases of partial or mucosal prolapse.

The Altemeier procedure (also known as a proctosigmoidectomy) involves removing the prolapsed part of the rectum and suturing the cut edges together.

Thiersch wiring is a temporary procedure that involves wiring the anal verge to narrow the opening. The procedure is extremely painful.

Because the perineal approach is minimally invasive, it has several advantages, including:

• Reduced operative time
• Blood loss is reduced.
• Improved recovery time
• Less post-operative discomfort

1. Approaches to abdominal repair

To view and operate in the abdominal cavity, an incision in the abdominal muscles is required. This procedure is most commonly performed under general anaesthesia on healthy adults. The following are the two most common types of abdominal repair:

Rectopexy (fixation [reattachment] of the rectum). Rectopexy can also be done laparoscopically via small keyhole incisions.

For patients with severe constipation, resection (removal of an intestine segment) is followed by rectopexy. This can also be done laparoscopically.