Rectal prolapse

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Rectal prolapse
Classification and external resources

Severe rectal prolapse
ICD-10K62.3
ICD-9569.1
OMIM176780
DiseasesDB11189
MedlinePlus001132
eMedicinemed/3533
MeSHD012005
 
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Rectal prolapse
Classification and external resources

Severe rectal prolapse
ICD-10K62.3
ICD-9569.1
OMIM176780
DiseasesDB11189
MedlinePlus001132
eMedicinemed/3533
MeSHD012005

Rectal prolapse refers to a condition where part of the wall of of the rectum prolapses (falls down) from their normal anatomical position. The term rectal prolapse often is used synonymously with complete rectal prolapse (external rectal prolapse), where the rectal walls have prolapsed to a degree where they protrude out the anus and are visible outside the body. [1] This may occur during with straining to defecate, or occur at rest.

Contents

Classification

Prolapses may involve the full thickness of the rectal wall, or the rectal mucosa only (mucosal prolapse). They may be external (complete) if they protrude from the anus and are visible externally, or internal if they do not protrude externally. There are 3 main conditions which come under the title rectal prolapse:

The term intussusception refers to invagination, or infolding. When the term "intussusception" is used by itself, this usually refers to a condition where one segment of the intestine (or bowel) folds within another. This can be a medical emergency, in contrast with rectal intussusception which is not life threatening. Rectal intussusception refers to the prolapsed section of bowel folding back on itself.

A. full thickness external rectal prolapse, and B. mucosal prolapse. Note circumferential arrangement of folds in full thickness prolapse compared to radial folds in mucosal prolapse.[6]

A group of conditions known as "Mucosal prolapse syndrome" (MPS) has now been recognized. It includes solitary rectal ulcer syndrome, rectal prolapse, proctitis cystica profunda, and inflammatory polyps.[7][8] It is classified as a chronic benign inflammatory disorder. The unifying feature is varying degrees of rectal prolapse, whether internal intussusception (occult prolapse) or external prolapse.

Causes

Rectal prolapse is caused by the weakening of the ligaments and muscles that hold the rectum in place. In most people, the anal sphincter is weak. Rectal prolapse may occur due to the following causes: long-term anal penetration,[citation needed] long-term constipation, long-term straining during defecation,[9][10][11] long term diarrhea[citation needed], high gastrointestinal helminth loads (e.g. Whipworm),[12] pregnancy and stresses of child-birth, previous surgery, cystic fibrosis, C.O.P.D., and sphincter paralysis.

Progression

The condition of rectal prolapse, a type of rectal rupture, undergoes progression, beginning with prolapsation during bowel movements, through Valsalva maneuvers (sneezing and so forth), then through daily activities such as walking until finally it may become chronic and ceases to retract.

Treatment

Micrograph showing a rectal wall with changes seen in rectal prolapse. H&E stain.

Partial prolapse may be treated by a diet high in fiber.[13]

Pharmaceutically, the condition may only be treated secondarily (by treating constipation) so as to avoid further straining.

The alternative is surgery. It may be divided into two forms of procedure: abdominal surgery and perineal surgery.

Recently, robotic-assisted surgery has been introduced as a treatment option.[16]

Notes

Because most sufferers are elderly, the condition is generally under-reported.[17] The condition can also occur in children.[18]

Deliberate prolapse ("rosebud")

This is a prolapse which occurs as a result of intentional dilatation of the anal sphincter for sexual gratification. The colloquial term for the prolapse which results intentionally during sexual activity is a "rosebud".[citation needed] This is a type of sexual fetishism and is associated with 'fisting' and 'anal stretching' - insertion of the hand into the rectum or dilatation of the anus with sexual aids.

See also

References

  1. ^ Altomare, Donato F.; Pucciani, Filippo (2007). Rectal Prolapse: Diagnosis and Clinical Management. Springer. p. 12. ISBN 978-88-470-0683-6. 
  2. ^ Tou, S; Brown, SR; Malik, AI; Nelson, RL (2008 Oct 8). "Surgery for complete rectal prolapse in adults.". Cochrane database of systematic reviews (Online) (4): CD001758. PMID 18843623. 
  3. ^ Altomare, Pucciani (2007) p.14
  4. ^ Altomare, Pucciani (2007) p.44-45
  5. ^ Diehl, 1Theodore M. (2005). Advanced therapy in gastroenterology and liver disease. PMPH-USA. p. 521. ISBN 978-1-55009-248-6. 
  6. ^ Hammond, K; Beck, DE; Margolin, DA; Whitlow, CB; Timmcke, AE; Hicks, TC (2007 Spring). "Rectal prolapse: a 10-year experience.". The Ochsner journal 7 (1): 24–32. PMID 21603476. 
  7. ^ Nonaka, T; Inamori, M; Kessoku, T; Ogawa, Y; Yanagisawa, S; Shiba, T; Sakaguchi, T; Gotoh, E; Maeda, S; Nakajima, A; Atsukawa, K; Takahasi, H; Akasaka, Y (2011). "A case of rectal cancer arising from long-standing prolapsed mucosa of the rectum.". Internal medicine (Tokyo, Japan) 50 (21): 2569–73. PMID 22041358. 
  8. ^ Abid, S; Khawaja, A; Bhimani, SA; Ahmad, Z; Hamid, S; Jafri, W (2012 Jun 14). "The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases.". BMC gastroenterology 12 (1): 72. PMID 22697798. 
  9. ^ Turell, R. (Apr 1974). "Sexual problems as seen by proctologist.". N Y State J Med 74 (4): 697–8. PMID 4523440. 
  10. ^ Essential Revision Notes in Surgery for Medical Students By Irfan Halim; p139
  11. ^ Hampton, BS. (Jan 2009). "Pelvic organ prolapse.". Med Health R I 92 (1): 5–9. PMID 19248418. 
  12. ^ "Trichuris Trichiura". Whipworm. Parasites In Humans. http://www.parasitesinhumans.org/trichuris-trichiura-whipworm.html. 
  13. ^ http://www.webmd.com/digestive-disorders/tc/rectal-prolapse-treatment-overview
  14. ^ a b Tjandra, Joe Janwar; Clunie, Gordon J. A.; Kaye, Andrew H.; Smith, Julian (2006). Textbook of surgery. Wiley-Blackwell. p. 247. ISBN 978-1-4051-2627-4. 
  15. ^ Houry, S.; Lechaux, J. P.; Huguier, M.; Molkhou, J. M. (1987). "Treatment of rectal prolapse by Delorme's operation". International Journal of Colorectal Disease 2 (3): 149–152. doi:10.1007/BF01647997. PMID 3309100.  edit
  16. ^ Heemskerk J, de Hoog DE, van Gemert WG, Baeten CG, Greve JW, Bouvy ND (November 2007). "Robot-assisted vs. conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time". Dis. Colon Rectum 50 (11): 1825–30. doi:10.1007/s10350-007-9017-2. PMC 2071956. PMID 17690936. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2071956/. 
  17. ^ "Professional Guide to Diseases". Lippincott Williams & Wilkins. 2008. p. 294. ISBN 978-0-7817-7899-2. 
  18. ^ Saleem MM, Al-Momani H (2006). "Acute scrotum as a complication of Thiersch operation for rectal prolapse in a child". BMC Surg 6: 19. doi:10.1186/1471-2482-6-19. PMC 1785387. PMID 17194301. http://www.biomedcentral.com/1471-2482/6/19. 

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