How is rectal prolapse graded?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 25, 2024
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Rectal prolapse is generally graded into three degrees: first degree rectal prolapse, second degree rectal prolapse, and third degree rectal prolapse. First degree rectal prolapse is a relatively minor condition where the rectal mucosa protrudes but can retract back on its own. Second degree rectal prolapse is a moderate condition where the protruding mucosa extends approximately 5-10 centimeters, generally forming a conical shape, and requires the patient to manually reposition it. Third degree rectal prolapse indicates a severe condition, with the prolapsed mucosa typically extending beyond 10 centimeters. It may protrude with each incident and could also occur when the patient strains the abdomen or squats. The treatment of second and third degree rectal prolapse generally requires surgical intervention.

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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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What are the symptoms of rectal prolapse?

Rectal prolapse is a common clinical disease in proctology, primarily affecting children, postpartum women, and the elderly. Symptoms of rectal prolapse include varying degrees of bloating and a feeling of falling at the anus. Sometimes, due to the accumulation of mucosa at the anal opening, normal defecation is impeded, leading to constipation and difficulty in bowel movement. To examine and diagnose rectal prolapse, an anoscopy is necessary. Under anoscopy, the relaxed mucosa that accumulates can be seen at the mirror opening. Treatment for rectal prolapse in children may involve the use of traditional Chinese medicine retention enemas, which can gradually alleviate the prolapse as the body's condition improves. For postpartum women or the elderly, treatment may also involve traditional Chinese medicine retention enemas in combination with surgical excision. The primary surgical procedure used is a Hemorrhoidal mucosal circular stapling operation.

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How to check for rectal prolapse?

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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Can you have children with rectal prolapse?

If a patient is diagnosed with rectal prolapse, they can still have children. However, childbirth can potentially worsen rectal prolapse, especially during natural delivery, where excessive straining in the pelvic and anal areas can exacerbate the condition. Therefore, if a patient already has rectal prolapse, it is advised to consider surgical removal treatment before pregnancy. If rectal prolapse occurs during pregnancy, external wash medications and hot compresses can be used to promote retraction. If rectal prolapse occurs during delivery, surgical treatment can also be carried out after childbirth. However, it is recommended that patients with severe rectal prolapse undergo cesarean delivery to avoid the excessive strain during natural childbirth, which could worsen the prolapse.

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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.