Rectal Prolapse is a medical condition when the rectum turns itself inside out and protrudes out through the anus. In the initial stages, this rectum is pushed out while passing bowels and goes back inside by itself, but if this goes on without treatment, it is required to be pushed back in, manually, in later stages.
The treatment options for rectal prolapsed are somewhat different for children and elderly, in whom it is found the most.
Laparotomy is an open abdominal surgery which is used for treating rectal prolapses. In this surgery, a cut or incision is made in the abdomen, after which overlying organs are moved aside.
Then the protruding rectum is lifted, pulled and stitched to the inner area of the central bone of pelvis. To carry out this, a short length of bowel may need to be removed.
Laparoscopy does not involve a large incision in abdomen, instead it is the keyhole abdominal surgery used to correct rectal prolapse. However, it is possible only in few cases. It involves use of slender instruments which are inserted inside the abdomen through a large number of small incisions. This is done to tether rectum into place and has become increasingly popular these days. The recovery time for it is quicker than open abdomen surgery.
The anal surgery is usually done for the elderly and is performed under anaesthesia. In anal surgery, the prolapsed part of rectum is initially removed and then structural damage is repaired.
After that, the bowel is again joined and returned through the anus, in order to restore appearance and near normal bowel function. However, the results of the abdominal surgery are regarded better and long lasting than the anal surgery.
Silicone rubber band perianal suture technique has become popular these days especially for frail and elderly patients of rectal prolapse. This has worked satisfactorily with a minor procedure having little morbidity.
For those who are not fit for surgery, a subcutaneous circumanal rubber ring is fitted. The rectum is kept off from prolapsing by keeping restricted the size of the anal lumen. However, it is often too tight or too loose which may lead to failure due to recurrent prolapsed or constipation.
Prolapse can be reduced initially by gentle digital pressure or by sprinkling prolapsed with sugar or salt. The first treatment should be done by laxatives, bulking agents and stool softeners. Constipation and diarrhea are contributing factors for rectal prolapsed and their occurrence should be minimized. This can be done by taking in correct diet that includes fresh veggies, fruits and lots of fiber. Rectal prolapse is a common ailment which is treated by a colon and rectal surgeon.
Contemporary evaluation of anatomy and function has now allowed a better choice for operation. However, no one operation can consistently provide best results for all patients and it should depend on their acceptable risk factor.
In a mucosal sleeve resection a circumferential cut or incision is made in mucosa of prolapsed rectum somewhere near dentate line. The mucosa is first stripped from rectum to the apex of the prolapsed section and then excised. Thereafter denuded prolapsed muscle is pleated using a suture and is reefed with transected edges sutured together. This is generally used for small prolapses but can also be used to treat large ones.
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