Rectal prolapse is a very common condition nowadays especially in elderly people. Prolapse is when any body part slips or falls down from its normal position. Rectal prolapse is when the rectum drops down or slides out of anus.
There are three types of prolapse:
External prolapse: The entire rectum sticks out of anus.
Mucosal prolapse: Part of the rectal lining pokes out of anus.
Internal prolapse: The rectum has started to drop but is not yet sticking out of anus.
It causes severe pain and discomfort & the patient will not be able to sit properly in chronic cases. Pain, swelling, wounds and other complications may be present, too. Most of the cases of rectal prolapse responds well to treatment but surgery is needed for a permanent cure.
Signs and symptoms
- Feeling a bulge outside the anus
- A red mass outside the anal opening
- Pain in the anus or rectum
- Bleeding from the rectum
- Leaking blood, faeces, or mucus from the anus
Causes
- Long-term history of diarrhoea or constipation
- Habit of straining
- Old age, with weakened muscles and ligaments in the rectal area
- Previous injury to the hip or anus
- Nerve damage that affects the muscles’ tonicity & elasticity, caused by conditions like pregnancy, vaginal childbirth complications, anal sphincter paralysis, or injury to the spine.
- Neurological problems, such as spinal cord disease or spinal cord transection
Pathophysiology
The pathophysiology of rectal prolapse is not completely understood or agreed upon. There are two main theories, which essentially are different ways of expressing the same idea.
The first theory postulates that rectal prolapse is a sliding hernia through a defect in the pelvic fascia. The second theory holds that rectal prolapse starts as a circumferential internal intussusception of the rectum beginning 6-8 cm proximal to the anal verge. With time and straining, this progresses to full-thickness rectal prolapse, though some patients never progress beyond this stage.
Diagnosis
- Clinical examination including ano-rectal examination
- Anal electromyography
- Anal manometry
- Anal ultrasound
- Pudendal nerve terminal motor latency test
- Proctography
- Colonoscopy
- Proctosigmoidoscopy
- MRI
Treatments
In earlier stages, taking stool softeners and replacing rectum by hand may suffice. However, eventually, surgical correction is necessary.
The two most common types of surgery:
- Abdominal: This type of surgery can be done either with a large incision or using laparoscopy, which uses small cuts and a camera attached to an instrument so the surgeon can see what needs to be done and if there are any additional issues that need to be fixed.
- Perineal: Also called rectal repair, this approach may be used if patient is older or have other medical problems. This type of surgery can involve the inner lining of the rectum or the portion of the rectum extending out of the anus.
Prognosis
- The prognosis for elderly patients presenting with rectal prolapse is variable and depends on the nature of any underlying or associated problems and the age and general well-being of the patient.
- Spontaneous resolution usually occurs in children but a minority of children who experience rectal prolapse continue to experience it in their adult lives.
Complications
- Rectal damage like ulceration or bleeding
- Permanent prolapse that cannot be replaced by hand
- Strangulation
- Gangrene
Disease & Ayurveda
Gudabhramsa
Nidana
Atisara – diarrhoea
Excessive pravaahana or straining when done by a person with dry, weak & emaciated body.
Purvaaroopa
Not mentioned
Samprapti
Not mentioned
Lakshana
Prolapsed rectum through anus
Divisions
Not mentioned
Prognosis
Yaapya
Chikithsa
Samana
Snehana
Swedana
Goshphanabandha(with a hole in the middle, for letting the Vaayu out)
Sodhana
Not advised
Commonly used medicines
Chiruvilwadi kashayam
Gandharvahastadi Kashayam
Dusparsakadi Kashayam
Gandharavahastadi kashayam
Undurutailam
Kaisore Guggulu
Kanchnar Guggulu
Ashwagandha
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
No home remedy is proven to cure rectal prolapse. In local traditions, a pack prepared of Turmeric and Achyranthes aspera in a cotton piece is used to apply to the prolapsed rectum and the mass will shrink and get back to normal position. Cissampelos pareira leaves are also used in the same manner.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil
Freshly cooked and warm food processed with minimal spices.
Behaviour:
Protect yourself from extreme hot & cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://pubmed.ncbi.nlm.nih.gov/24352613/
- PMID: 29336759
A retrospective study to review pediatric robotic rectopexy experience from 2012 to 2015 was done at a single institution. Four pediatric patients underwent a robotic rectopexy for rectal prolapse from 2012 to 2015. Three patients were male and one was female. The mean age was 15.5 years. Three patients were completed robotically, and one patient required conversion to an open procedure. The average postoperative length of stay was 3.25 days. There were no episodes of recurrent prolapse. The study concluded that Robotic rectopexy provided a safe, reliable, and short-term resolution of rectal prolapse in pediatric patients.
- PMID: 32424455
A study aimed to compare ventral mesh rectopexy (VMR) and pelvic organ prolapse suspension surgery (POPS) in management of patients presenting with rectal prolapse was done. The study was a prospective cohort trial in which 120 female patients with complete rectal prolapse were included, 60 patients had had VMR and the other 60 had had POPS as a surgical management for complete rectal prolapse. The patients were assessed 6 months postoperatively. There was no significant statistical difference regarding hospital stay and postoperative pain. Operative time was significantly shorter in POPS in comparison with VMR. VMR showed slight improvement regarding constipation and continence scores; however, this was statistically significant. VMR showed less complications compared to POPS. The study concluded that POPS is comparable to VMR in management of rectal prolapse and in improving the ODS symptoms. Thus, POPS can be used as easier, faster option to treat rectal prolapse in selected patients.
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
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