Rectal prolapse (rectal prolapsing)

Rectal prolapse (rectal prolapsing)

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Rectal prolapse is protrusion of rectal mucosa or the entire rectal wall through the anus. There are three types of rectal prolapse. Partial or no mucosal prolapse. Rectal mucosa protrudes from the outside through the anus usually prepare defecation act. This pathological condition may be confused with internal hemorrhoids. Partial prolapse is encountered in children under 2 years. Prolapsing rectal prolapse is complete or protrusion of the entire rectal wall through the anus. The onset can be triggered only in defecation. Along the rectal tissue will remain permanently protrude. Intusussceptia prolapse is protrusion of the internal-internal part of the rectum in a wider upper colon (telescoping). This clinical form is more common in children and rarely affects adults.
Transient prolapse is characterized by temporary protrusion of the rectal mucosa just outside the anus, often in healthy children, triggered by forcing a bowel movement. Prolapse in adults tends to be persistent and severe.
Case in children is still unknown etiology in adults is related to an intestinal disease, such as polyps or tumors. Risk factors that compete at the beginning and rectal prolapse include: forcing a bowel movement because of constipation, anal sphincter damage during vaginal birth or ano-rectal surgery, congenital abnormalities of the rectum, pelvic floor muscle weakening.
The clinical picture associated with rectal prolapse include: fecal incontinence, the removal of mucus and blood through the anus, urge to defecate without the presence of a chair, stool feeling stuck in the anal canal, anal pain and itching.
Rectal prolapse in children usually resolves spontaneously. Treatment of rectal prolapse in adults include dietary changes, laxatives and drugs, surgical procedures. The type of treatment depends on the type of prolapse, associated comorbidities, age, activity level and ability to seek treatment at home. Home therapies are usually the first option because surgery does not always cure the disease. Changes in diet reduces constipation and defecation forcing act. Adding water increases the amount of fiber in his chair and help to mobilize the colon.
If rectal prolapse is not relieved by special diet and medical care methods at home, giving the surgical resection. The type of surgical procedure is indicated by the size of prolapse and the patient's overall health. They use two types of surgery. Rectopexia protruzionate portion is withdrawn through a incision in the abdomen, rectum paraombilicala. This may be an indication of rezecdtie or not. This procedure is applied especially to young and healthy patients. A second procedure used includes hypotonic anal sphincter suture through a perineal incision. It is indicated especially in older patients with associated comorbidities. Surgery is effective for patients who have residual control over the anal sphincter. If it is destroyed and prolapse can be corrected only partially fecal incontinence.
Pathogenesis
Rectal prolapse was a common condition especially after 50 years and decrease the incidence seems to be due to improved diet and hygiene in industrialized countries. Rectal mucosal prolapse may involve externalization, as the easiest and most common clinical pediatric population, or may involve full-prolapsing rectal wall.
Most cases occur in pediatric patients under 4 years, with the highest incidence in the first year of life. Anatomical considerations on debut so early in the life of rectal prolapse include: Rectum, along the vertical surface of the sacrum and coccyx stimte -Position relative koasa rectum in relation to other pelvic organs High-mobility of the sigmoid colon Lack of support-anal levator muscle Rectal mucosa, loss of adhesion to the underlying layers Houston-valve to 75% absence of children.
Factors that predispose to rectal prolapse include: increased intra-abdominal pressure during defecation coercion, diarrhea, parasitic diseases and cancer, cystic fibrosis, malnutrition by ischiorectale fat loss, ulcerative colitis, Hirchsprung disease, Ehlers-Danlos syndrome, pertussis, rectal polyp.
Although cystic fibrosis is a common diagnosis in patients with rectal prolapse, testing for this condition is indicated in all patients who do not show a change in anorectal anatomy. Rectal prolapse occurs in 20% of patients with cystic fibrosis aged between 6 months and 3 years.
There are two main theories that attempt to explain the pathophysiologic mechanisms triggering of rectal prolapse. The first theory postulates that rectal prolapse is a sliding hernia printrun defect in the pelvic fascia. A second theory suggests that rectal prolapse begins as an internal circumferential rectal intusussceptie 6-8 cm proximal to the anal limit. As time progresses and forcing it to defecation complete rectal prolapse, although some patients will never pass this point.
Some anatomical evidence discovered during surgery performed to treat rectal prolapse are common to most patients. These include a weak anal sphincter with diastase levatorilor a Douglas bag above the deep, posterior rectal fixation with a poor long-rectal and rectosigmoid mesentery redunctant. If these anatomical elements are the cause or the result of the rectum prolapsarii still do not know with certainty.
Mucosal prolapse is most likely a different etiology compared to the full and internal intusussceptia. It occurs when tissue is lost those application rectal mucous membrane, allowing it to externalize through the anus. It is triggered by forcing a bowel movement and is treated as such.
Anorectal anatomy
The rectum is the distal portion of 12-15 cm from the anal canal up to the sigmoid colon. Its main role is as a reservoir for feces.
Mucosa is the innermost layer of the intestinal lumen.
Internal anal sphincter is a circular smooth muscle is the most distal extension of the colon and rectum circular muscle. It has a length of 2. 5-4 cm and width of 2-3 mm. It is not under voluntary control and is placing permanent contracts to avoid loss of seat.
External anal sphincter is a striated muscle that forms a circular tube around the anal canal. Part of the levator muscles with a single functional complex puborectali. Control of external anal sphincter is voluntary.
Dentate line is the junction between the ectoderm and endoderm of the anal canal.
Causes and Risk Factors
Factors that predispose to this condition include rectal pathology: -Abdominal pressure rise: constipation, diarrhea, intestinal parasites, tumors , Malnutrition, cystic fibrosis, the loss of fat ischiorectale , Ulcerative colitis, Hirschsprung disease, Ehlers-Danlos syndrome -Meningomyelocele, rectal polyps To pertussis and chronic obstructive pulmonary disease-COPD, frequent coughing which increases intra-abdominal pressure Anoractale-surgery that injures the anatomical integrity of pelvic floor and anal sphincters Spinal-cord disease that affects the normal functionality of the rectum or associated muscles: Multiple Sclerosis Megacolon, congenital birth vaginally.