Causes of rectal prolapse

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 26, 2024
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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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How is rectal prolapse graded?

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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Can rectal prolapse heal itself?

Rectal mucosal prolapse primarily refers to a condition where the rectal mucosa becomes excessively relaxed, accumulates near the anus, and presents symptoms such as a distinct feeling of fullness and downward pressure at the anal area. Sometimes, the prolapsed mucosa may congest the anal opening, causing difficulty in defecation or even constipation. Rectal mucosal prolapse cannot heal completely on its own. Treatment options include medication to alleviate symptoms or surgery to remove the prolapsed mucosa. Patients with rectal mucosal prolapse should avoid straining excessively during bowel movements. If constipation occurs, patients should not strain too hard and may use enemas to assist with bowel movements.

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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 eat black fish with rectal prolapse?

Patients with rectal prolapse are advised not to consume seafood, lamb, and other stimulating foods for long periods or in excessive amounts. Overconsumption of lamb, seafood, or spicy and stimulating foods can easily lead to dry stools. When stools are dry, patients will involuntarily strain during bowel movements, which can worsen the rectal prolapse. In addition to needing a light and liquid diet, patients with rectal prolapse require prompt treatment to prevent the condition from worsening and delaying the disease. The primary treatment method is surgical removal combined with local sclerosing agent injection therapy. After surgery, it is important for patients to avoid squatting or excessive physical exercise for up to six months to prevent episodes of rectal prolapse.

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Can glycerin suppositories be used for rectal prolapse?

If a patient experiences difficulty in defecation or constipation due to rectal prolapse, enemas can be used to help facilitate bowel movements. The basic principle behind the defecation difficulties caused by rectal prolapse is due to the prolapsed, lax mucosa blocking the anal opening, preventing normal excretion of stool. Alternatively, when excretion does occur, it may be impeded by the mucosal obstruction, obstructing the normal passage of feces. Therefore, besides using enemas to address difficulty in defection and bowel movement, it is more necessary to surgically remove the lax mucosa to achieve a fundamental treatment. The use of enemas alone can only provide temporary relief of symptoms and does not address the root cause of the problem. For rectal mucosal prolapse, a stapled hemorrhoidopexy can be performed to surgically remove the prolapsed mucosa.