prolapus-kucuk-kapak

The Definition of Rectal Prolapse

It is a condition in which the attachments that ensure the fixation of the rectum are weakened/loosened and come out of the anus. During each straining, the rectum comes out of the anus partially or completely. Sometimes, it returns to its place by itself and sometimes it is pushed inside by the patient with a finger. It rarely leads to a situation that requires urgent intervention. However, this situation may impair a person’s quality of life.
It is mostly an advanced age disease and is 5 times more common in women above 50 years of age than men. While women with prolapse are mostly in the age of 60 years, a small number of prolapses are observed in men before 40 years of age, and individuals with autism, growth retardation and psychological problems and taking multiple medications.

The causes that increase prolapses are as follows:
1– The lack of bowel movements
2– Prolonged constipation (in 15% of patients with diarrhea)
3–Women who give normal birth (in a large number).

Symptoms - Findings

1– Decreased bowel sounds.
2– The bowel that comes out of the anus with straining (the patient describes it as sitting on a small ball)
3– It takes its place either by itself or by being pushed with a hand
4– At first, gas and then fecal incontinence

5– The large intestine that comes outside gets thick over time, and it may make a wound and bleed over time. The person consults a doctor with the concern of bleeding.

In the diagnosis,
a)The onset and course of the disease are questioned
b) The anus is evaluated by examination
c) Anal manometry (the process of measuring the pressure of the anus)
d) Rectosigmoidoscopy (Endoscopy of the last 40 cm of the large intestine from the anus)
e) Colonoscopy (observation of the entire large intestine with a colonoscope)

– It should be distinguished from hemorrhoid.
– In case of doubt in the diagnosis, defecography should be performed.
The sagging bladder or uterus problems that may be found by defecography can also be observed. If the patient is subject to surgical treatment, other correction procedures may also be performed in the same session.
– For the purpose of investigating the underlying cause, the graphs of the colonic transit time should be taken (CTT – Colonic transit time)

Treatment

  1. Non-operational optionsThe part that comes out of the anus can grow over time. It may come outside easily. However, as the patient delays surgical treatment, the problems of postoperative gas and fecal incontinence – although different from person to person – become more permanent. This situation is serious.
    2. Operational optionThe aim is to prevent the rectum from coming outside again.a. Abdominal surgery
    b. Rectal surgery

    The type of surgery to be performed differs according to the patient’s age, current medical conditions, bowel functions, surgeries undergone previously, and the surgeon’s experience. In young people who do not have any other medical problems and who are expected to have a long life expectancy can be operated with the abdominal approach (with a laparoscopic camera or by the open method). In those with the high risk of anesthesia, the rectal approach may be preferred.