Let's learn more about Rectal Prolapse.

When you go to the bathroom, do you feel like part of your bowel is coming out of your anus? Or do you always feel a fullness, heaviness, or discomfort in your anus? Many people don't tell anyone about these things out of shame or fear. But today we are talking about ' Rectal Prolapse ', a condition that affects many people, but is a little embarrassing to talk about, but which you should be aware of.

Simply put, what is Rectal Prolapse?

Think about our digestive system. The food we eat goes through our intestines, gets digested, and the waste products are passed out of our body as feces. Before being passed out, this feces is temporarily stored in the last part of our large intestine. This is called the rectum . The muscles inside this rectum hold it in place.

Now, Rectal Prolapse is when the muscles that hold the rectum in place weaken, causing the rectum to slip down from its normal position, down the anus, and sometimes completely out of the body. It's like a telescope going in, where part of the intestine goes in and part of the rectum comes out.

Why is this happening? What are the reasons for this?

There are many reasons why the muscles that hold the rectum in place can become weak. It may not be a single cause, but a combination of several factors.

Isn't this hemorrhoids? How do you tell the two apart?

This is a big problem for many people. Many people confuse the two because the symptoms of both Rectal Prolapse and Hemorrhoids are sometimes similar. However, these two are two completely different conditions.

Let us clearly understand the difference between these two.

What are the symptoms of this?

A person with this condition may experience a variety of symptoms. While these may not be severe at first, they can increase over time.

• A feeling or fullness as if there is something like a ball in the anus.
• Even after going to the toilet, it feels like you haven't really pooped .
• A red, fleshy lump comes out when you go to the toilet. At first, this goes in on its own, but later you have to manually insert it.
• Leakage of mucus-like fluid, blood, or stool from the anus (Fecal Incontinence).
• Itching and pain around the anus.
• Constipation or difficulty passing stool.

How does a doctor find this?

If you have these symptoms, the best thing to do is see a doctor. The doctor will ask you about your symptoms and do a physical exam. They may ask you to wipe your as if you were going to the bathroom and examine your rectum.

In addition, you can perform the following tests to confirm the condition and check for other problems:

• Digital Rectal Exam: A routine examination performed by the doctor using a gloved finger.
• Anorectal Manometry: A test that measures the strength of the muscles in the rectum and anus.
• Defecography: A test that uses an X-ray or MRI scan to videotape the activity of your rectum while you defecate.
• Colonoscopy: A flexible tube with a camera is inserted through the anus to examine the entire colon.
• Lower GI Series (Barium Enema):A liquid called barium is given, and a series of X-ray videos are taken as it passes through the intestines.
• Electromyography (EMG): A test that checks for damage to the nerves that control muscle function.

What happens if left untreated?

This is not a life-threatening condition, but if left untreated for a long time, the discomfort can increase and serious complications can occur.

• Fecal incontinence: This is a condition in which the muscles in the rectum tighten, causing the inability to control the passage of stool and air. This problem affects 50%-75% of people with this condition.
• Rectal Ulcers: The part of the rectum that comes out can become irritated and bleed from rubbing against clothing and drying out.
• Incarceration: Sometimes the part of the rectum that has come out cannot be put back in. This is a somewhat dangerous situation.

What are the treatments for this?

When this condition occurs in an adult, it does not get better on its own. Usually, the best treatment for this is surgery . If this condition occurs in young children, it may get better on its own once the cause (e.g. constipation) is eliminated.

There are two main types of surgery. Your doctor will determine the most appropriate surgery for you based on your health condition and the nature of the prolapse.

1. Abdominal Approach - Rectopexy

This involves making an incision in the abdomen (either open surgery or laparoscopically or via keyhole surgery), pulling the prolapsed rectum back up, and fixing it to the back wall of the pelvic cavity with stitches or something like mesh. These surgeries are very successful.

2. Perineal Approach

This method is used for people who cannot have abdominal surgery, are elderly, or have other medical conditions. In this method, the surgery is performed through the anus.

• Altemeier Procedure: In this procedure, the protruding part of the intestine is cut out and removed, and the remaining two parts are reattached.
• Delorme Procedure: In this procedure, only the prolapsed mucosal lining of the rectum is removed, and the muscle layer is folded and sewn together.

Can this situation be prevented?

Yes, this risk can be reduced to some extent. These things are also important to prevent this condition from recurring after surgery.

• Control constipation: Eat a diet rich in fiber (fruits, vegetables, legumes). Drink at least 8-10 glasses of water a day. Avoid straining when going to the bathroom.
• Strengthen your pelvic floor muscles: The best exercise to do this is Kegel exercises . You can ask your doctor or physical therapist for advice on how to do these.
• Maintain a healthy weight: Excess weight puts extra pressure on the muscles of the pelvic floor.