Rectal prolapse, procidentia

Patients with rectal prolapse will notice a large amount of tissue projecting from the anus.  It will usually be the size of a plum, at least.  Most patients referred to the Pezim Clinic with a diagnosis of rectal prolapse do not have it.  They are, instead, prolapsing either internal hemorrhoids or a bit of the lining mucosa of the rectum (mucosal prolapse).  True rectal prolapse, sometimes called rectal procidentia, is rare.  It generally occurs in elderly women and is associated with a weakened anal sphincter and reduced continence control.  A specialist is usually required to distinguish true rectal prolapse from these other lesser conditions.

Treatment for rectal prolapse is surgical.  In the younger fitter patient, an operation through the abdomen is preferred.  It involves lifting the rectum up in the abdomen, attaching it to a firm structure (the sacrum), and sometimes resecting a portion of the redundant bowel (sigmoid colon).  In an elderly patient who can tolerate surgery, the prolapsing bowel is more often removed from below, so that there are no abdominal incisions.  This procedure is called an Altemeier Procedure, and can be performed under spinal anesthetic.  The results of the Altemeier Procedure are probably less long-lasting than the abdominal repair, but it is safer, and in an elderly patient it makes more sense.

Lesser prolapses such as hemorrhoidal prolapse or mucosal prolapse may be treated by rubber band ligation or surgical excision through the anus.

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