Intestine out of anus

What Is Rectal Prolapse?

Learn what can cause a protrusion of the rectum outside the anus.

Rectal prolapse occurs when part or all of the rectum slides out of place and sticks out of the anus, turning the rectum “inside out.”

The rectum is the final section of the large intestine before the anus (the opening through which stool passes out of the body).

Rectal prolapse is an uncomfortable condition that requires treatment to fix.

What Causes Rectal Prolapse?

There’s no single definitive cause of rectal prolapse, although a number of known factors can increase your risk of developing this condition.

Risk factors for rectal prolapse include:

  • Chronic constipation (difficult bowel movements that happen less than three times in a week)
  • Chronic diarrhea (bowel movements are watery or runny, and happen more than three times a day on a regular basis)
  • Long-term history of straining during bowel movements
  • Weak muscles in the pelvic area
  • History of pelvic surgery
  • Having given vaginal birth

Rectal prolapse is a rare condition. It affects fewer than 3 in every 100,000 people.

Rectal prolapse can happen at any age, but it’s most common in adults. Women over age 50 are six times more likely than men over 50 to develop rectal prolapse.

Rectal Prolapse Symptoms

Rectal prolapse may be uncomfortable, but it’s not usually painful.

Symptoms of rectal prolapse may include:

  • Bright red tissue sticking out of the anus (the tissue might be bloody or have mucus on it, and it may move back inside the body on its own or stay outside the anus)
  • An uncomfortable sensation like something is falling out, or like you’re sitting on a ball
  • Trouble beginning a bowel movement
  • Feeling like you can’t completely empty your bowels
  • Fecal incontinence (inability to control your bowel movements; feces may leak out unexpectedly)

Surgery for Rectal Prolapse

Treatment for rectal prolapse depends on the severity of your symptoms.

Some people with rectal prolapse may need surgery. Surgery can keep rectal prolapse from happening again.

There are two types of surgical procedures that are typically used to treat rectal prolapse:

Abdominal repair Surgery to fix rectal prolapse is usually done “through the belly.”

Abdominal surgery for rectal prolapse usually involves making a small cut in the lower abdomen.

The surgeon will then pull the rectum upward and attach it to a small bone in the lower back so that it can’t slip out again.

Rectal repair In this type of surgery, the surgeon works through the anus rather than making an incision in the abdomen.

This surgery is often performed on older patients or those with more medical problems.

The two most common rectal procedures include:

Altemeier procedure In this procedure, the surgeon cuts off or removes a portion of the rectum that extends outside the anus.

The remaining rectum is pushed back inside the body and attached to the inside of the anus.

Delorme procedure In this procedure, the inner lining of the fallen rectum is removed. The outer lining is then folded and sewn back so that it no longer protrudes.

Other Rectal Prolapse Treatments

Other treatments for rectal prolapse include:

  • Laxatives, to reduce straining during bowel movements
  • Enemas, to help empty your bowels
  • Pelvic floor or “Kegel” exercises, to help strengthen the muscles that control bowel movements
  • A high-fiber diet (containing at least 25 to 30 grams of fiber per day)

Pelvic Organ Prolapse (dropped bladder, bowel, rectum, uterus)

As you age, your organs can shift positions. Pregnancy, childbirth or extra weight can stretch and weaken muscles that support your pelvic organs. A sheet of muscles and ligaments called the pelvic floor supports the uterus, small bowel, colon and bladder. If pelvic floor muscles are weak, your organs may drop and bulge into the vagina. When that happens, you may feel like something is falling out of your vagina or you may have a sensation of fullness or pain. It can also become difficult to hold urine or have a bowel movement.

There are several types of prolapse:

  • Cystocele–tissues between the vagina and bladder weaken, and the bladder falls into the vagina
  • Rectocele–tissues between the vagina and rectum weaken, and the rectum falls into the vagina
  • Enterocele–the small bowel falls through the apex of the vagina, often after a hysterectomy
  • Uterine prolapse–the uterus descends into the vaginal vault, or in severe cases, outside of the vagina

Risk factors include previous childbirth (usually more than one vaginal delivery), chronic constipation, coughing, as from chronic bronchitis or smoking, obesity, age, hysterectomy and menopause. There also may be slight genetic risk.

You may have a single prolapse or a combination. We can determine this through a pelvic examination. Because prolapse is associated with aging and low estrogen levels, topical estrogen creams or vaginal tablets may be prescribed. They can strengthen tissues and promote surgical healing, without entering your bloodstream in significant quantities. If you have total prolapse, surgery may be necessary. We have a highly specialized team experienced in open and robotic vaginal surgery.
Prolapse may occur with or without stress incontinence, urge incontinence or mixed incontinence. We will treat them together.

Cystocele (Dropped Bladder)

You may feel a bulging in the vaginal area or a fullness or pressure in the pelvis or vagina, or you may feel like you are sitting on a ball. The sensation may go away when you lie down. You may feel discomfort when you cough or lift something. You may feel like you are not emptying your bladder completely, or may leak urine when you laugh, cough or sneeze. Intercourse may be painful, and you may have frequent bladder infections.
Treatment options range from no treatment for a mild cystocele to surgery for a serious cystocele. If a cystocele is not bothersome, you may need only to avoid heavy lifting or straining that could cause the cystocele to worsen. If symptoms are moderately bothersome, we may recommend a pessary–a ring-like device placed in the vagina to hold the bladder in place.
Large cystoceles may require surgery to move and keep the bladder in a more normal position. The tissues between the vagina and bladder can be tightened and supported with sutures or with a mesh insert.
Pelvic floor physical therapy can help strengthen tissues. You also should avoid smoking, gaining weight, bearing down, straining and coughing as much as possible.

Rectocele (Dropped Rectum)

You may feel a fullness or pressure in the vaginal area, and have trouble passing stool. You may also feel rectal pressure or fullness, and feel that you can’t completely empty your bowel. You may experience discomfort with intercourse.
Diagnosis is made with a pelvic and rectal exam. Treatment for mild prolapse may include pelvic floor physical therapy and stool softeners to avoid constipation and straining. For severe prolapse, we can perform surgery to strengthen and support the tissues between the vagina and rectum with sutures.

Enterocele (Dropped Bowel)

Less common than other types of prolapse, this generally only occurs after the uterus has been removed. Symptoms include a feeling of fullness, pressure or pain in the vaginal and pelvic area, a pulling sensation or low back pain that eases when you lie down, and painful intercourse.
Enterocele is diagnosed through a pelvic exam. It can be treated with a pessary–a ring-like device placed in the vagina to hold the bowel in place–or surgery. A pessary needs to be replaced periodically to avoid infection or ulcers. Surgery involves pushing the bowel back into place and using sutures to tighten muscles and ligaments that support it.

Uterine Prolapse

We will refer you to a gynecologist for treatment.

Pelvic Organ Prolapse

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Treatment

Pelvic organ prolapse (POP) is not a dangerous medical condition. Treatment options range from doing nothing and observing your condition over time to surgery to correct the prolapse. The choice of treatment typically depends on how your POP affects your quality of life, on your overall health and on your physician’s expertise.

Nonsurgical options

  • Observation. If you’re not having symptoms, or your symptoms are not interfering with your quality of life, you should choose a wait-and-see approach. Every year, you undergo a complete examination to evaluate your POP. Just make sure you contact your health care professional if your condition changes during the year. If you have no symptoms, treatment cannot improve your quality of life and should be avoided.

  • Addressing symptoms. Another option is to address any symptoms you have without actually “fixing” the underlying prolapse. For instance, if you’re experiencing urinary or fecal incontinence, your doctor may recommend Kegel exercises (described below) or medication. If you are constipated and straining with bowel movements, then changing your diet, adding fiber supplements or taking medications such as laxatives may help.
    • Kegel exercises. These exercises strengthen your pelvic floor, which can help strengthen your organs in the pelvic region and may relieve pressure from prolapse. To make sure you know how to contract your pelvic floor muscles correctly, try to stop the flow of urine while you’re going to the bathroom. If you can do this, you’ve found the right muscles. But do not do the actual exercises while stopping the stream of urine or you may develop a voiding dysfunction.
      To do Kegel exercises, empty your bladder and sit or lie down. Contract your pelvic floor muscles for three seconds, then relax for three seconds. Repeat 10 times. Once you’ve perfected the three-second contractions, try doing the exercise for four seconds at a time and then resting for four seconds, repeating 10 times. Gradually work up to keeping your pelvic floor muscles contracted for 10 seconds at a time, relaxing for 10 seconds in between. Aim to complete a set of 10 exercises, three times a day.
  • Pessaries. Pessaries are diaphragm-like devices placed in the vagina to support the pelvic organs. They are commonly used in women with POP to reduce the frequency and severity of symptoms, delay or avoid surgery and prevent the condition from worsening.
    Most pessaries are made from silicone, plastic or medical-grade rubber. Silicone is probably best, since it is nonallergenic, doesn’t absorb odors or secretions, can be repeatedly cleaned and is pliable and soft. You typically remove the pessary at bedtime and replace it in the morning, although you can arrange to remove it less often or have it removed and cleaned at your doctor’s office. Most doctors prescribe vaginal estrogen with a pessary in postmenopausal women to prevent any irritation of the vaginal walls.
    Pessaries do not have good long-term track records. In women who get fitted for and start to use a pessary, about 40 percent stop using it within one to two years.
  • Bladder support devices. These are new over-the-counter supports (brand name Poise Impressa) that are inserted into the vagina like a tampon but have a soft supportive frame inside. They reduce the movement of the urethra with exercise, coughing and sneezing, thereby reducing or eliminating leakage in women for whom these activities are problematic and cause stress incontinence. The device is not absorbent and can be inserted for eight hours. There is minimal risk or discomfort.

Surgery

An estimated 11 percent to 19 percent of women will undergo surgery for POP or urinary incontinence by age 85, and 30 percent of these women will require an additional surgical procedure. The goal of surgery for POP is to improve your symptoms by addressing the underlying cause. Surgery can be reconstructive, which corrects the prolapsed vagina while maintaining or improving sexual function and relieving symptoms, or obliterative, which moves the organs back into the pelvis and partially or totally closes the vaginal canal.

Surgery may involve repairs to any pelvic organs, including the various parts of the vagina, the perineum (the region between your vagina and anus), bladder neck and anal sphincter (anus). The goal of surgery is to reposition the prolapsed organs and secure them to the surrounding tissues and ligaments.

Although hysterectomy is still commonly performed in women with symptomatic POP, several other surgical procedures are available. Which your doctor recommends depends on your condition and the specific type of prolapse. Surgeries can be performed through an abdominal incision, vaginally or laparoscopically, with or without robotic assistance, through small incisions in your belly.

Studies find that the vaginal or laparoscopic approach results in fewer wound complications, less postoperative pain and shorter hospital stays than with open abdominal surgery. Today, a large number of POP surgeries are performed vaginally, laparoscopically or robotically. However, all forms carry a risk of relapse.

In terms of the surgery itself, procedures vary depending on the type of prolapse. In most cases, surgery for POP is performed under general or regional anesthesia (epidural or spinal), and patients may stay in the hospital overnight.

Here’s an overview of the surgical procedures used to treat the various forms of POP:

  • Rectal prolapse (rectocele). Surgery to repair a rectocele, or prolapse of the rectum, is performed through the vagina. The surgeon makes an incision in the wall of the vagina and secures the rectovaginal septum, the tissue between the rectum and the vagina, in its proper position using the patient’s connective tissue. The opening of the vagina is tailored to the appropriate dimension, and extra support is reinforced between the anal opening and the vaginal opening.
  • Bladder prolapse (cystocele). Surgery to correct bladder prolapse, or cystocele, is usually performed through the vagina. The surgeon makes an incision in the vaginal wall and pushes the bladder up. He or she then uses the connective tissue between the bladder and the vagina to secure the bladder in its proper place. If urinary incontinence is also a factor, the surgeon may support the urethra with a sling made out of a special nylon like material.
  • Prolapse of the uterus (uterine descensus). In postmenopausal women or women who do not want more children, prolapse of the uterus is often corrected with a hysterectomy. In women who want more children, a procedure called uterine suspension may be an option. Some doctors now use laparoscopic surgery or vaginal surgery to repair the ligaments supporting the uterus so that hysterectomy is not necessary. This operation requires only a short hospital stay, has a quicker recovery time and involves less risk than a hysterectomy. The long-term results, however, are still being studied, so talk to your health care professional about what’s right for you. If you have heavy bleeding or other uterine problems, you may want to consider hysterectomy, but if there are no other problems than prolapse, the ligament repair may be preferable. Generally, surgery for prolapse is not recommended until after you have completed childbearing because pregnancy can make it worse.
  • Vaginal vault prolapse and herniated small bowel (Enterocele). Vaginal vault prolapse and herniated small bowel often occur high in the vagina, so surgery to correct the problems may be done through the vagina or the abdomen. There are a number of surgical procedures used to treat these forms of POP. The most common involves vaginal vault suspension, in which the surgeon attaches the vagina to the sacrum or to the sacrospinous ligament. This can be done through an incision in the abdomen, by laparoscopy (belly button surgery) or via robotic surgery. Robotic surgery takes many hours but accomplishes the surgery without a big incision. Sacrospinous ligament suspension is done through the vagina and is very effective as well. It can result in temporary buttock pain.
    It is important to be aware that fixing POP is a significant cause of incontinence with activity (stress incontinence). The abdominal/laparoscopic route results in leakage of urine in 26 percent of women who did not leak before, and the vaginal route results in a 40 percent risk of leakage. This is not always severe and does not always require treatment, but it should be explained and discussed before any surgery. Most women who undergo surgery to fix POP do not leak, but a significant number do. Some women opt for a preventive sling procedure to avoid this risk.

Prevention

Preventing pelvic organ prolapse (POP) begins in your teens. Get in the habit of practicing Kegels or pelvic tilts as done in yoga several times a day, until doing them becomes as routine as brushing your teeth.

When you get pregnant, make sure you’re aware of the risks and benefits of a forceps delivery in case one is necessary. A forceps delivery creates a very high risk for incontinence and prolapse. Talk to your health care professional about the options of a vacuum delivery or a cesarean section.

Maintaining a healthy weight and quitting smoking may also help prevent pelvic floor problems, including POP.

You should also avoid straining during bowel movements and when lifting heavy items, and if you have a chronic cough, get it checked out. Chronic coughing creates the kind of straining that can lead to POP.

A man in China developed a rare condition after playing games on his phone while sitting on the toilet: His rectum slipped out of his anus, according to news reports.

The man went to a hospital in southeast China after he noticed a “ball-sized” lump had fallen out of his anus but was still attached to his body, according to the Daily Mail.

The man was diagnosed with rectal prolapse, a relatively uncommon condition in which the rectum, or the last part of the large intestine, becomes detached from inside the body and essentially turns itself “inside out,” allowing it to slip out of the anus, according to the American Society of Colon and Rectal Surgeons (ASCRS).

The condition affects about 2 out of every 100,000 people, and up to two-thirds of patients with the condition have chronic constipation, ASCRS says. Rectal prolapse is most common in women over age 50, but it can occur in younger adults and children as well, according to the Cleveland Clinic.

The exact cause of the condition is unclear, but certain factors may play a role, including loose muscles of the anal sphincter (the muscle that controls the release of stool), previous injury to the anal or pelvic areas, damage to the nerves in the rectal area; chronic constipation or straining during bowel movements, and infections with intestinal worms, according to the Cleveland Clinic.

The man told his doctors that he had been playing mobile games while trying to have a bowel movement for more than half an hour, according to the Daily Mail. He had experienced rectal prolapse in the past (since he was 4 years old), but on previous occasions, the rectum had retracted to its normal position, according to his doctors.

The man underwent surgery to treat his condition, the Daily Mail reported.

Original article on Live Science.

What Is Anal Cancer?

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other parts of the body. To learn more about how cancers start and spread, see What Is Cancer?

Anal cancer starts in the anus. To understand anal cancer, it helps to know about the anus and how it works.

The anus

The anus is the opening at the lower end of the intestines. It’s where the end of the intestines connect to the outside of the body.

As food is digested, it passes from the stomach to the small intestine. It then moves from the small intestine into the main part of the large intestine (called the colon). The colon absorbs water and salt from the digested food. The waste matter that’s left after going through the colon is known as feces or stool. Stool is stored in the last part of the large intestine, called the rectum. From there, stool is passed out of the body through the anus as a bowel movement. The anal sphincter (SFINK-ter) muscles control the passing of stool. These are ring-shaped muscles around the anus that keep stool from coming out until they are relaxed during a bowel movement.

Types of Colon and Rectal Surgery

Surgeries performed by MedStar Health colon and rectal surgeons include:

  • Colectomy
  • Colostomy
  • Endoscopic Surgery
  • Hemorrhoidectomy
  • Ileal Pouch Anal Anastomosis (J-Pouch)
  • Inflammatory Bowel Disease (IBD) Surgery
  • Internal Sphincterotomy
  • Rectopexy
  • Resection

Colectomy

A colectomy, or, colon resection, removes all or part of the large intestine.

  • Segmental Colectomies: Generally, a vertical incision is made in the middle of the abdomen, overlying the portion of the bowel with disease. The segment of bowel containing the disease is removed. If the excision is for cancer, an effort is made to remove a wider segment to include lymph nodes. The ends of the bowel are joined together (anastomosis) to be water-tight and permit healing.
  • Polypectomy: A surgeon may remove a cancerous polyp or polyps from the colon or rectum using a colonoscope. The colonoscope is inserted into the rectum and a wire loop is passed through the instrument to remove the polyp.
  • Total Colectomy and Total Proctocolectomy: A few diseases, such as familial polyposis, require removal of the entire colon with anastomosis of the end of the small bowel to the rectum. Familial polyposis or ulcerative colitis often require removal of the colon and rectum. A new pouch (neorectum) is created with the small bowel folded and stapled back on itself; this pouch is joined down to the anus.

Colostomy

A colostomy is a surgical procedure during which your surgeon creates a hole in your abdominal wall and pulls one end of the colon through the opening. Surgeons perform colostomy procedures to treat a number of colon and rectal conditions.

A colostomy procedure fundamentally alters how your body excretes waste and fecal matter. While you will need some time to get used to living with a colostomy, you will find that you can live a full life, complete with all the activities you enjoyed previously. The area where the new opening sits is called a stoma. This is where waste matter will exit your body. After your colostomy, you will need a colostomy bag, which collects the waste from your body. The bag lies outside of your body. Before you are discharged, a trained ostomy nurse will teach you how to care for your stoma and manage the bag.

The colostomy is either temporary or permanent:

  • Temporary colostomies are performed for specific conditions that allow for the reattachment of the colon at later point in time. The colostomy allows the affected area to heal because the stool is not passing through the area. Once the affected area has healed, you undergo a colostomy reversal procedure.
  • Permanent colostomies are used in cases of chronic disease, such as Crohn’s disease and diverticular disease. Your surgeon may also remove the infected area of the colon or rectum.

Endoscopic Surgery

Endoscopic surgery is performed using a scope, a flexible tube with a camera and light at the tip. This allows your surgeon to see inside your colon and perform procedures without making major incisions, allowing for easier recovery time and less pain and discomfort. Snaring is the most common surgical procedure that can be performed through any of the endoscopes. A snare is a wire formed like a lasso that is looped over a tumor and tightened; then the wire is electrified to prevent bleeding as it cuts through.

Endoscopic procedures are most often used for diagnosis.

Hemorrhoidectomy

Your doctor may first recommend nonsurgical treatments for hemorrhoids, including lifestyle changes and medications. If you tried home treatments and did not feel sufficient relief, you may be a candidate for surgery. Surgery for hemorrhoids is called a hemorrhoidectomy. During a hemorrhoidectomy, your doctor will place you under local anesthesia and make incisions around your anus to remove the hemorrhoids. A hemorrhoidectomy is generally an outpatient procedure, meaning you can go home the same day. You may feel some tenderness around the incisions. Hemorrhoidectomy often provides the best long-term results for hemorrhoids.

  • Procedure for prolapse and hemorrhoids (PPH), also known as stapled hemorrhoidectomy is a minimally invasive procedure to treat hemorrhoids and prolapse. During PPH, your doctor will use a circular stapling device to reposition the hemorrhoidal tissue back to its original position in the anus and trim the tissue that is causing pain. PPH reduces the blood flow to the hemorrhoids, causing them to shrink. PPH is a highly effective procedure, but surgeons must undergo special training to perform it effectively.
  • In addition to PPH, your surgeon may use rubber band ligation, where a rubber band is placed around the hemorrhoid to cut off its blood supply and destroy the tissue.

Ileal Pouch Anal Anastomosis (J-Pouch)

Ileal pouch anal anastomosis (IPAA), also called the J-pouch procedure, is a procedure to create a pouch from the end of your small intestine and attach the pouch to the anus. If you need to have your large intestine (colon) removed, IPAA restores your stool function. Surgeons perform IPAA for patients who needed their large intestine removed during a procedure called a colectomy, or colon resection. Patients can live without a colon, but bowel control can be problematic. IPAA helps restore control over bowel function.

IPAA is a life-altering procedure. However, you are in expert hands at MedStar Health. Our entire medical team will work with you before, during and after your surgery to help you manage life with a J-pouch. Most patients find that after a period of adjustment, they are able to return to and enjoy all of their favorite activities.

Benefits

The advantage of the J-pouch is that it eliminates the need for the permanent opening (stoma) and waste bag. The procedure preserves the anus, and the internal pouch serves as the storage place for stool. This allows you to maintain bowel control and eliminate waste through the anus.

Procedure

In the procedure,

  • Your surgeon removes your large intestine and create the pouch from the small intestine. He or she then creates a temporary ileostomy, which you will have for two months, during which time your bowel and the new pouch have time to heal.
  • After two months, you have a second operation, and your surgeon reverses the ileostomy. The pouch is now where stool will collect. You retain control of the anal muscles, allowing you to eliminate waste normally.
  • After the procedure, you will probably have more bowel movements compared to those without a pouch, but it does not greatly interfere with your quality of life.

Inflammatory Bowel Disease (IBD) Surgery

Inflammatory bowel disease (IBD), which primarily includes ulcerative colitis and Crohn’s disease, causes flare-ups of intense intestinal pain that may require hospitalization. Your doctor will probably first recommend lifestyle changes and medications to relieve symptoms of IBD. However, if you do not find relief through nonsurgical methods, you may be a candidate for a surgical procedure.

Surgeons perform surgery to remove the colon (colectomy) to treat ulcerative colitis and Crohn’s disease. The surgery is highly effective against ulcerative colitis, curing the disease and removing the risk of colon cancer. For Crohn’s disease, the surgery can provide long-term relief from flare-ups, lasting as long as a few years. Unfortunately, there is no cure for Crohn’s disease, and the disease usually returns.

Internal Sphincterotomy

Surgeons often perform an internal sphincterotomy to treat anal fissures (small tears in the mucous lining of the rectum). Fissures often resolve on their own, through dietary changes and medications. However, if you have not found relief through nonsurgical methods, you may be a candidate for an internal sphincterotomy. The internal sphincter is the muscle in your body that opens and closes to allow stool to pass from the body. The goal of an internal sphincterotomy procedure is to stretch or cut the internal sphincter to weaken the muscle temporarily, allowing it to heal.

During an internal sphincterotomy, your doctor will use a local anesthetic to numb the area, or a spinal anesthetic, which numbs the entire lower body. In some cases, general anesthesia may be used. They will make a small incision in the internal anal sphincter to reduce pressure on the muscle. Keep in mind that a sphincterotomy does not close the actual fissure. Anal fissures must heal on their own; a sphincterotomy lessens the spasms and relaxes the muscle, thus allowing the fissure to heal and close.

Rectopexy

Rectopexy is a surgical procedure to treat rectal prolapse. Some patients with mild cases of rectal prolapse may find relief by altering their diet or using laxatives or stool softeners. However, if these methods did not adequately improve your symptoms, you may be a candidate for rectopexy. This procedure repositions the internal structures and secures them in place.

Before Surgery

Prior to rectopexy, you will need to undergo a bowel-cleansing regimen, so your digestive system is free of stool for the procedure. During rectopexy, your surgeon will make an incision along your abdomen, separate the rectum from the surrounding tissues, and lift the rectum and suture it to the sacrum, or lower backbone, possibly using a mesh-like material to provide extra reinforcement. Your surgeon may perform this surgery in conjunction with anterior resection surgery, during which part of your colon (large intestine) is removed.

After Surgery

Following your surgery, you will need to give your body time to heal. Our medical team will discuss the recovery period with you. You will need to follow a liquid diet until your bowel function returns to normal, restrict certain activities that place strain on your abdomen, including lifting, and avoid coughing and straining during bowel movements. Complete recovery takes about four to six weeks.

Resection

A resection is a surgical procedure to remove all or part of a diseased organ or tissue.

  • Abdominoperineal (Rectal) Resection: This surgery is performed to treat anal and distal rectal cancer. The anus, rectum and part of the sigmoid colon are removed to include the attending vessels and lymph nodes. The end of the colon is then brought through an opening made in the abdominal wall (this is called a colostomy).
  • Small Bowel Resection: This surgery is performed to remove Crohn’s disease, cancer, ulcers, benign tumors, and polyps. This surgery removes a portion of the small intestine. The surgeon will remove the diseased parts of the small intestine and sew the healthy parts back together. If necessary, an opening to the outside of the body called an ostomy is created.
  • Low Anterior Resection: In this operation, part of the rectum is removed, but it is rejoined (anastomosed). Entailed in this operation is dissection deep into the pelvis. Anastomoses at this deep level are at increased risk to leak, so often, an ostomy is created above to stop the pressure of bowel movements. Another risk in the deep pelvic dissection is injury to nerves that serve the bladder and sex organs, which may cause later dysfunction.
  • Laparoscopic Colon Resection: Several techniques in laparoscopic colon resection are being used to treat colorectal cancer. The laparoscope is a lighted tubular instrument used to examine abdominal organs when passed through a small abdominal incision. Laparoscopic colon resection uses this minimal-access approach for removing cancerous tissue and lymph nodes.
  • Local Full-Thickness Resection of the Rectum: Very early stage rectal cancer can be treated by cutting through all layers of the rectum to remove the cancer and some surrounding normal tissue.

Rectal Prolapse

What is rectal prolapse?

Rectal prolapse occurs when the rectum (the last section of the large intestine) falls from its normal position within the pelvic area and sticks out through the anus. (The word “prolapse” means a falling down or slipping of a body part from its usual position.)

The term “rectal prolapse” can describe three types of prolapse:

  • The entire rectum extends out of the anus.
  • Only a portion of the rectal lining is pushed through the anus.
  • The rectum starts to drop down but does not extend out the anus (internal prolapse).

Rectal prolapse is common in older adults who have a long-term history of constipation or a weakness in the pelvic floor muscles. It is more common in women than in men, and even more common in women over the age of 50 (postmenopausal women), but occurs in younger people too. Rectal prolapse can also occur in infants – which could be a sign of cystic fibrosis – and in older children.

Is rectal prolapse just another name for hemorrhoids?

No. Rectal prolapse results from a slippage of the attachments of the last portion of the large intestine. Hemorrhoids are swollen blood vessels that develop in the anus and lower rectum. Hemorrhoids can produce anal itching and pain, discomfort and bright red blood on toilet tissue. Early rectal prolapse can look like internal hemorrhoids that have slipped out of the anus (i.e., prolapsed), making it difficult to tell these two conditions apart.

What causes rectal prolapse?

Rectal prolapse can occur as a result of many conditions, including:

  • Chronic (long-term) constipation or chronic diarrhea
  • Long-term history of straining during bowel movements
  • Older age: Muscles and ligaments in the rectum and anus naturally weaken with age. Other nearby structures in the pelvis area also loosen with age, which adds to the general weakness in that area of the body.
  • Weakening of the anal sphincter: This is the specific muscle that controls the release of stool from the rectum.
  • Earlier injury to the anal or pelvic areas
  • Damage to nerves: If the nerves that control the ability of the rectum and anus muscles to contract (shrink) are damaged, rectal prolapse can result. Nerve damage can be caused by pregnancy, difficult vaginal childbirth, anal sphincter paralysis, spinal injury, back injury/back surgery and/or other surgeries of the pelvic area.
  • Other diseases, conditions and infections: Rectal prolapse can be a consequence of diabetes, cystic fibrosis, chronic obstructive pulmonary disease, hysterectomy, and infections in the intestines caused by parasites – such as pinworms and whipworms – and diseases resulting from poor nutrition or from difficulty digesting foods.

What are the symptoms of rectal prolapse?

The symptoms of rectal prolapse include the feeling of a bulge or the appearance of reddish-colored mass that extends outside the anus. At first, this can occur during or after bowel movements and is a temporary condition. However, over time – because of an ordinary amount of standing and walking – the end of the rectum may even extend out of the anal canal spontaneously, and may need to be pushed back up into the anus by hand.

Other symptoms of rectal prolapse include pain in the anus and rectum and bleeding from the inner lining of the rectum. These are rarely life-threatening symptoms.

Fecal incontinence is another symptom. Fecal incontinence refers to leakage of mucus, blood or stool from the anus. This occurs as a result of the rectum stretching the anal muscle. Symptoms change as the rectal prolapse itself progresses.

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A to Z: Rectal Prolapse

May also be called: Rectal Procidentia

Rectal prolapse is a condition in which part of the rectum slips down (prolapses) and protrudes through the anus.

More to Know

The rectum is the last part of the large intestine. It’s where stool (poop) is stored until it leaves the body through the anus as a bowel movement. Certain conditions can cause the rectum to prolapse, which literally means “to fall out of place.” When this happens, part of the rectum sticks out through the anus.

There are two kinds of rectal prolapse:

  1. With mucosal prolapse, only the lining (mucosa) of the rectum protrudes through the anus.
  2. With complete prolapse, the actual wall of the rectum may protrude out as much as 2 inches (5 centimeters) or more, especially following a bowel movement. Rectal prolapse is usually painless, but it can cause mild discomfort, bleeding, and loss of bowel control.

Causes of rectal prolapse include chronic constipation; diseases that cause diarrhea; infection with parasites; malnutrition; cystic fibrosis; and increased pressure in the abdomen from excessive vomiting, toilet training, straining during bowel movements, or prolonged coughing.

Rectal prolapse most commonly affects young children and the elderly. Treatment usually requires a doctor to gently push the prolapsed rectum back into place, but in some cases, particularly with adults, surgery may be needed to correct the condition.

Keep in Mind

A rectal prolapse usually doesn’t cause pain, and treating the cause usually cures the prolapse. About 90% of kids under 3 years old who get rectal prolapse can be treated without surgery, and in many of those cases a prolapse won’t occur again. Surgery, when necessary, usually is successful.

All A to Z dictionary entries are regularly reviewed by KidsHealth medical experts.

Rectal prolapse repair

Rectal prolapse may be partial, involving only the inner lining of the bowel (mucosa). Or, it may be complete, involving the entire wall of the rectum.

For most adults, surgery is used to repair the rectum because there is no other effective treatment.

Children with rectal prolapse do not always need surgery, unless their prolapse does not improve over time. In infants, prolapse often disappears without treatment.

Most surgical procedures for rectal prolapse are done under general anesthesia. For older or sicker people, epidural or spinal anesthesia may be used.

There are three basic types of surgery to repair rectal prolapse. Your surgeon will decide which one is best for you.

For healthy adults, an abdominal procedure has the best chance of success. While you are under general anesthesia, the doctor makes a surgical cut in the abdomen and removes a portion of the colon. The rectum may be attached (sutured) to the surrounding tissue so it will not slide and fall out through the anus. Sometimes, a soft piece of mesh is wrapped around the rectum to help it stay in place. These procedures can also be done with laparoscopic surgery (also known as keyhole or telescopic surgery).

For older adults or those with other medical problems, an approach through the anus (perineal approach) might be less risky. It might also cause less pain and lead to a shorter recovery. But with this approach, the prolapse is more likely to come back (recur).

One of the surgical repairs through the anus involves removing the prolapsed rectum and colon and then suturing the rectum to the surrounding tissues. This procedure can be done under general, epidural, or spinal anesthesia.

Very frail or sick people may need a smaller procedure that reinforces the sphincter muscles. This technique encircles the muscles with a band of soft mesh or a silicone tube. This approach provides only short-term improvement and is rarely used.

Summit Medical Group Web Site

What is an intestinal obstruction?

An intestinal obstruction is a blockage of the small or large intestine (also called the small or large bowel). The blockage makes it hard for the contents of the bowel to pass through and out of the body. If the obstruction is only partly blocking the intestine, you may feel some relief of crampy abdominal pain and fullness as you pass liquid stool or gas. Sometimes the blockage cuts off blood flow to part of the bowel. When this happens, the bowel is said to be strangulated. The lack of blood flow can cause death of some of the tissue and can be life threatening.

The most common cause of an intestinal obstruction is scar tissue (adhesions) from previous surgeries. Other causes of a blockage may include:

  • Cancer
  • Inflammation of the bowel from conditions such as Crohn’s disease or diverticulitis
  • Twisting of the bowel
  • A hard lump of stool (fecal impaction)
  • Intussusception, which is the intestine folding into itself, cutting off the flow of partly digested food and eventually cutting off blood flow to the tissues
  • Narrowing of the bowel that has been present since birth

What can I expect in the hospital?

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring

  • You will be checked often by the hospital staff.
  • Your heart rate, blood pressure, and temperature will be checked regularly.
  • Your blood oxygen level may be monitored by a sensor that is attached to your finger or earlobe.

Testing

Your healthcare provider will ask about your medical history and symptoms, and perform a physical exam. The following tests may also be done:

  • Blood tests to check for infections or blood loss
  • Tests of bowel movements to check for blood or infection
  • Tests to look for abnormalities in the intestine and abdomen, which may include:
    • X-rays: Pictures of the inside of the abdomen and the intestines to check for a blockage
    • Computed tomography (CT) scan: A series of X-rays taken from different angles and arranged by a computer to show thin cross sections of the intestines
    • Upper gastrointestinal (GI) endoscopy (esophagogastroduodenoscopy or EGD): A test in which a long, slim, flexible, lighted tube is put down the mouth, through the stomach, and into the intestine to look for a blockage. Sometimes one or more pieces of tissue are removed to help make a diagnosis. This is called a biopsy.
    • Sigmoidoscopy or colonoscopy: A test in which a long, flexible tube and tiny camera is put into the rectum and up into the colon to look for a blockage. Sometimes a biopsy will be done to help make a diagnosis.
    • Barium enema: An X-ray taken of the belly (abdomen) after a special dye is inserted through the rectum to show the walls of the intestine and any possible problems
    • Ultrasound scan: Sound waves and their echoes are passed through the body from a small device (called a transducer) that is held against your skin to create pictures of the inside of the abdomen and intestines
    • Laparoscopy: A surgical procedure in which a small cut is made near the bellybutton (navel) and your healthcare provider inserts a lighted tube with a camera through the cut and into your abdomen to look at the organs and pelvic cavity. Sometimes a biopsy may be done to help make a diagnosis.

Treatment

The treatment for an intestinal obstruction depends on its cause.

  • You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow for medicine to be given directly into your blood and to give you fluids, if needed.
  • You may not be allowed to eat a regular diet until after the cause of the intestinal obstruction is found and treated.
  • You may have a tube put through your nose down into your stomach, called a nasogastric or NG tube. The tube may be used to give fluids or medicine, or with suction to help remove fluid and air and relieve pressure in the stomach and intestine.
  • You may have a tube inserted into the rectum, called a rectal tube, to help fix an obstruction caused by a twisted bowel and relieve pressure in the intestine from bowel gas.
  • If the blockage is a hard lump of stool near the anus, it may be possible to remove it with an enema or a gloved finger. This may require several enemas and may be very uncomfortable.
  • Your provider may prescribe medicine to:
    • Treat pain
    • Treat or prevent an infection
    • Prevent side effects, such as nausea or constipation, from other treatments
    • Soften stool and reduce straining with a bowel movement
  • You may need surgery to treat the intestinal obstruction. Surgery may include:
    • Ladd procedure: If the obstruction is caused by a twist in the intestine, the surgeon may straighten it out and tack it down so it cannot twist again. The appendix is usually removed during this surgery to prevent future problems. If the blood supply to part of the intestine was blocked by the twist, a section of intestine may need to be removed.
    • Colon resection: Surgery to remove the section of colon that was blocked or twisted. The ends of the intestine are then sewn back together
    • Colostomy: Surgery to remove a section of the colon. The healthy part of the remaining colon is attached to an opening in the wall of the abdomen. Bowel movements then pass through this opening instead of the rectum. They are collected in a bag outside the body. After the remaining colon heals, the colostomy can sometimes be reversed. This means that you will have a second surgery to rejoin the ends of the colon to each other and will no longer have a colostomy.
    • Lymphectomy: Surgery to remove lymph nodes in the abdomen if the blockage was caused by cancer to check if the cancer has already spread. It also allows the pathologist to determine the stage of the cancer accurately. This will allow your healthcare providers to determine if you need more treatment after you recover from surgery.
  • If you have had a colostomy:
    • You will have a pouch covering your stoma (the part of the intestine outside the body) to collect stool as it drains. Pouches must be emptied regularly so that they do not become too heavy and leak. Some pouches may be opened or unclamped at one end to allow drainage without removing the pouch. Other pouches can be removed, emptied, and cleaned before they are reattached. Be sure to follow the manufacturer’s directions for your type of pouch.
    • You will need to learn to care for your stoma and change the pouch.

What can I do to help?

  • You will need to tell your healthcare team if you have new or worsening:
    • Change in bowel habits, such as pain, mucus, diarrhea, constipation, or other intestinal problems
    • Abdominal bloating
    • Abdominal pain that goes away and then comes back worse than it was
    • Nausea or vomiting
    • Vomiting
    • Blood in your bowel movements
    • Blood in your vomit
    • Signs of infection around your surgical wound if you have had surgery. These include:
      • The area around the wound is more red or painful
      • The wound area is very warm to touch
      • You have blood, pus, or other fluid coming from the wound area
      • You have chills or muscle aches
  • Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you are in the hospital depends on many factors. The average amount of time to stay in the hospital with an intestinal obstruction is 4 to 6 days.

Everyone does it. And many have developed a set of rituals and beliefs, some false, about the act of clearing one’s bowels.

You might think that you know your stuff about poop, but misconceptions are common. Here is the truth behind five common misconceptions about defecating.

Misconception No. 1: Daily pooping is normal, and optimal.

The U.S. Army once encouraged its soldiers to perform three daily S’s, two of which are shower and shave. This might imply that the first S, which stands for, uh, defecating, is a healthy daily routine one should strive for. But it is latrine efficiency, not long-term health, that’s the Army’s top priority.

Gastroenterologists quip that anything in the range of three times daily to three times weekly is normal, assuming the feces isn’t too loose or hard. That is, regularity doesn’t mean defecation should happen daily, but rather, that it should happen consistently. Frequency only becomes a concern when it changes suddenly, in either direction.

Constipation is caused by many factors, such as poor diet, dehydration, lack of exercise, jet lag or diet change while traveling, pregnancy and certain medications. Getting a good rest, drinking more water, exercising and eating a high-fiber diet of grains, fruits and vegetables should remedy constipation. If not, a paucity of bowel movements could point to (or lead to) a serious medical condition.

Diarrhea, or loose bowel movements, also is caused by many factors, most commonly by viruses, bacteria or an allergic reaction. Consistently loose bowel movements could be a sign of a chronic disease, such as irritable bowel syndrome.

Misconception No. 2: It’s supposed to smell bad.

Poo may not smell like roses, but it shouldn’t smell like a rotting swamp of roses, either. A truly awful-smelling bowel movement — something admittedly hard to quantify in writing — can be either a sign of an infection, or something more serious, such as Crohn’s disease, celiac disease or ulcerative colitis.

Giardiasis, an infection of Giardia parasites, is one well-known cause of horrible-smelling poop. If you experience bad odor over a prolonged period when defecating, you should see a doctor.

Perhaps surprising, passing gas from morning through the night is normal and healthy, the natural byproduct of your gut bacteria digesting your food. But as with poop, consistently foul gas could be a sign of something serious.

Misconception No. 3: The colon needs a good flushing.

Colon cleansing is one of the worst things you can do for your colon and long-term health — despite its enduring popularity. At its most benign, colon cleansing is a waste of time and money. Recent studies, however, have revealed how truly detrimental the practice is.

In short, you cannot wash away the bad things without washing away the good things; but worse, there are no bad things to wash away. Those toxins and pounds of festering, impacted fecal matter? They don’t exist.

With each “cleansing,” you are flushing away beneficial bacteria and electrolytes. Nearly 1,000 species of bacteria reside in the colon and aid in the final stages of digestion, including water absorption, and the fermentation of fibers and vitamin absorption, particularly vitamins K, B1, B2, B7, and B12.

Emergency rooms regularly see patients who have hurt themselves by cleansing. Common side effects are dehydration, rectal perforations, air emboli, blood infections and a loss of the ability to control the muscles of the bowels.

There are no toxins in the colon that get absorbed in the blood to cause disease. This theory of autointoxication was proven incorrect more than 100 years ago. These toxins now reside in a virtual form on the Internet on hydrotherapy websites promoting, well, nothing but crap.

Misconception No. 4: Taking your time is healthy.

The myth that it’s healthy to sit on the toilet for a prolonged time pervades popular culture. The author Henry Miller dedicated a chapter in his 1952 tome “The Books in My Life” to reading on the toilet. Even an episode of the sitcom “Seinfeld” featured the character George being forced to buy an expensive picture book that he took into the bookstore’s restroom to read.

And magazines are found so often in people’s personal bathrooms that one might think it is natural, or even beneficial, to relax on the toilet. Not so, for two reasons.

Studies have shown a connection between toilet reading and hemorrhoids. The theory, dating back to a 1974 study, is that prolonged toilet sitting during which the anus is relaxed, followed by repeated straining, irritates the tissues surrounding the rectum that help control bowel movements, called anal cushions. This can lead to hemorrhoids, or inflamed veins in this area.

A study published in The Lancet in 1989 reported that patients with hemorrhoids were more than twice likely to read on the toilet. A study from 1995 in the journal Colon & Rectum found that 40 percent of patients with benign anorectal disease read on the toilet. And a 2009 study published in Neurogastroenterology & Motility also found hemorrhoids sufferers more likely to be toilet readers.

What’s not clear, however, is whether prolonged toilet sitting causes hemorrhoids, or is the result of this. Nevertheless, doctors recommend more dietary fiber, not more sitting, to facilitate bulkier and faster bowel movements.

The second reason toilet reading is a problem is filth. Myriad studies reveal how reading material and smart phones get contaminated with fecal matter when used on the toilet. It’s hard to wash an iPhone.

Misconception No. 5: More pooping leads to more weight loss

Seems like this one is aligned with the laws of physics: The more that comes out means the less you are carrying around. Alas, it isn’t (quite) so.

Many people take laxatives or drink “dieter’s tea” with the hope of pooping out more of those calories. The problem with this approach, though, is that calorie absorption takes place largely in the small intestine. Laxatives do their thing in the large intestine, or colon.

There is anecdotal evidence the Asians unload more feces on average per day than Westerners; and considering that most Asian countries have far lower obesity rates compared to most Western countries, you might start to think there’s something to the pooping-away-fat idea.

But what we are witnessing is the effect of a high-fiber diet, in which insoluble fiber provides a feeling of satiety without contributing many calories. That fiber comes in whole grains, beans, vegetable and vegetable skins, seeds and nuts — features of an Asian diet. High-fiber foods pack fewer calories per pound compared to low-fiber foods, such as meat and processed foods — hallmarks of a Western diet.

Fiber promotes stool regularity and vacates the body with impressive efficiency.

Follow Christopher Wanjek @wanjekfor daily tweets on health and science with a humorous edge. Wanjek is the author of “Food at Work” and “Bad Medicine.” His column, Bad Medicine, appears regularly on Live Science.

Neurogenic Bowel

What is neurogenic bowel?

Neurogenic bowel is the loss of normal bowel function. It’s caused by a nerve problem. A spinal cord injury or a nerve disease may damage the nerves that help control the lower part of your colon. This is the part of the body that sends solid waste out of the body. This condition gets in the way of your normal ability to store and get rid of waste. It often causes constipation and bowel accidents.

The food you eat goes to your GI (gastrointestinal) tract for digestion. You might think of your GI tract as a long tube. Here is how it works:

  • Muscles around the GI tract push the food by contracting and squeezing the tube in a wave-like pattern (peristalsis).
  • Starting at the mouth, food goes down the food pipe (esophagus) to the stomach.
  • It then goes into the intestines or bowel. The first part of the intestines absorbs the nutrients. The food your body can’t use then goes on into the large intestine (colon).
  • Your colon reabsorbs excess water from the undigested food (called stool). The stool is stored in the last part of the GI tract called the rectum.
  • Over time, your body removes the stool through the anus during a bowel movement. A ring of sphincter muscles keeps the stool inside the rectum until you have a BM.

The muscles and nerves around your rectum and anus need to work together for your bowels to work correctly. Nerves control the muscles of the rectum. They signal when the rectum is full. Damage to these nerves can interfere with bowel control. The damage may reduce the peristalsis in the muscles around the colon. The damage may block signals to or from the rectum and anus. This means you may not feel when you need to have a BM. Or you may not be able to have a BM when you want.

There are 2 main kinds of neurogenic bowel, depending on the nerves affected:

  • Reflex (spastic) bowel problem. This is when you can’t voluntarily relax the anal sphincter. You may have constipation. Signals between the colon and the brain become disrupted. In reflex bowel problems, the reflex that triggers a BM still works. But you may not feel it coming. An unplanned BM can happen when the rectum is full. A reflex bowel problem may occur after an upper central nervous system injury.
  • Flaccid bowel problem. This is reduced movement in the colon. There is less peristalsis, and the sphincter is looser than normal. This can lead to constipation with frequent leaking of stool. A flaccid bowel problem may follow a lower spinal cord injury.

Neurogenic bowel can lead to BM accidents (incontinence), constipation, and other problems. These problems can cause physical, social, and emotional difficulties. People with neurogenic bowel may be able to set up a bowel management program that helps to reduce problems.

Pelvic Organ Prolapse

Types of Pelvic Prolapse

The different types of prolapse are divided into categories according to the part of the vagina they affect: front wall, back wall or top of the vagina. You may have more than one type of prolapse.

  • Cystocele (fallen bladder) — This occurs when the bladder falls down into the vagina and creates a large bulge in the front vaginal wall. This may cause discomfort and difficulty emptying the bladder.
  • Uterine prolapse (fallen uterus) — This happens when the uterus drops down into the vagina and causes discomfort and difficulty having bowel movements. It’s the second most common type of prolapse and is classified into three grades depending on how far the uterus has fallen.
  • Vaginal vault prolapse (fallen/bulging vagina) — In women who have had a hysterectomy, it’s still possible for the vagina to fall down even though the uterus is no longer present. This is referred to as post-hysterectomy vaginal prolapse.
  • Enterocele (bulging of small bowels) — This occurs when a space between the vagina and rectum opens and the small bowel bulges through.
  • Rectocele (bulging rectum) — This occurs when the rectum falls. It may cause discomfort and difficulty having bowel movements.

Surgical Treatment

If nonsurgical treatments don’t work, we offer many different surgical options to correct pelvic organ prolapse. Often, more than one of these surgeries will be performed at the same time.

Vaginal Surgeries

In general, vaginal approach surgeries have a faster recovery time and cause less pain than abdominal surgeries.

  • Vaginal hysterectomy
  • Cystocele repair (anterior colporrhaphy)
  • Rectocele repair (posterior colporrhaphy)
  • Sacrospinous ligament suspension — This operation attaches the vagina to the sacrospinous ligament through the vagina.
  • Uterosacral ligament suspension — This procedure re-attaches the top of the vagina when it has come down.
  • Colpocleisis (vaginal shortening)
  • Total vaginal reconstruction

Abdominal Surgeries

In general, abdominal approach surgeries have a longer recovery time and cause more discomfort than vaginal surgeries.

  • Hysteropexy (uterine sparing): Your doctor makes incision on your abdomen and supports the uterus by stitching mesh to the front of the tailbone (sacrum).
  • Supracervical hysterectomy with sacrocolpopexy: Your doctor makes an incision on your abdomen and removes the uterus. This is different from a total hysterectomy in that your doctor doesn’t remove your cervix.
  • Abdominal sacrocolpopexy

Laparoscopic Reconstructive Surgery

Your doctor may perform an abdominal surgery laparoscopically, through several very small (1 cm) incision, with the use of a video camera. Abdominal sacrocolpopexy, paravaginal repair, and uterosacral ligament suspension can be done with the laparoscope. The recovery time is faster and postoperative pain is usually less than abdominal approach surgeries.

Robotic-Assisted Laparoscopic Surgery

A newer technology in laparoscopic surgery is robotically assisted laparoscopic surgery with the DaVinci robot. Your doctor may use this technique with an abdominal sacrocolpopexy. Similar to standard laparoscopy, this procedure requires a several very small (1 cm) incision and the use of a video camera. The advantage of this approach is faster healing time and shorter hospital stays than with a more traditional abdominal approach through a larger abdominal incision.

Causes of Prolapse

The causes of prolapse include:

  • Childbirth
  • Menopause
  • Obesity
  • Chronic cough
  • Prior pelvic floor surgery
  • Neurologic diseases, such as Parkinson’s disease, multiple sclerosis or a spinal cord injury
  • Ethnicity (prolapse is found more often in Caucasian and Hispanic women)

Symptoms of Pelvic Prolapse

Physical symptoms can include:

  • A bulge or lump on the outside of the vagina
  • Feeling as though something is bulging out of the vagina, like a tampon is about to fall out
  • Lower back pain or increased pelvic pressure that interferes with daily activities
  • Irregular vaginal spotting or bleeding
  • Frequent urinary incontinence, urinary tract infections, difficulty urinating, frequent urination or any of the above that interfere with a daily routine
  • Difficult or painful sexual intercourse
  • Difficult bowel movements, constipation or liquid stools

How We Diagnose Prolapse

An evaluation begins in your doctor’s office with questions about your health and health history.

  • Pelvic exam: usually done while you lie on an exam table, or sometimes while standing; your doctor may ask you to push down or cough to see the full extent of the prolapse.
  • Rectal exam: checks the strength of these muscles which can weaken with age or childbirth
  • Post-void residual (PVR): determines how much urine is left behind after you urinate
  • Urinalysis: determines if you have an infection or other substances found in the urine

Stages of Pelvic Organ Prolapse

  • Stage 0 : no prolapse, and the pelvic organs are perfectly supported by the ligaments in the pelvis
  • Stage 1: virtually no prolapse, and the pelvic organs are very well-supported by the ligaments in the pelvis
  • Stage 2: the pelvic organs are not as well supported by the ligaments and have begun to fall down but are still inside the vagina
  • Stage 3: the pelvic organs are beginning to bulge to or beyond the opening of the vagina
  • Stage 4: the pelvic organs are completely outside of the vagina

Author

Wilson, Donald A. M.D.

No Need to Suffer From Pelvic Organ Prolapse

Pelvic organ prolapse is a very common condition among women. It is estimated that half of women who have children will experience some form of prolapse; however, many women don’t seek help from a qualified doctor. Pelvic organ prolapse occurs when the pelvic floor becomes weak or damaged and can no longer support the pelvic organs. The womb (uterus) actually falls into the vagina. When the bladder and bowel slip out of place, they push up against the walls of the vagina. While prolapse is not a life threatening condition it may cause a great deal of discomfort and distress. There are a number of different types of prolapse that can occur in a woman’s pelvic area and these are divided into three categories according to the part of the vagina they affect: front wall, back wall, or top of the vagina. It is not uncommon to have more than one type of prolapse.

  1. Prolapse of the anterior (front) vaginal wall
    1. Cystocele (bladder prolapse) – When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall. It’s common for both the bladder and the urethra to prolapse together. This is called a cystourethrocele and is the most common type of prolapse in women.
  2. Prolapse of the posterior (back) vaginal wall
    1. Rectocele (prolapse of the rectum or large bowel) -This occurs when the end of the large bowel (rectum) loses support and bulges into the back wall of the vagina.
    2. Enterocele (prolapse of the small bowel) – Part of the small intestine may slip down between the rectum and the back wall of the vagina. This often occurs at the same time as a rectocele or uterine prolapse.
  3. Uterine prolapse is when the womb drops down into the vagina. It is the second most common type of prolapse.

Different factors contribute to the weakening of the pelvic floor support over time, but the most significant factors are thought to be:

  • Pregnancy and childbirth
  • Aging and menopause
  • Weight gain
  • Chronic coughing or strain
  • Heavy lifting
  • Previous pelvic surgery

Symptoms may include:

  • Feeling a lump or heavy sensation in the vagina
  • Lower back pain that may ease when you lie down
  • Pelvic pain or pressure
  • Pain or lack of sensation during sex

When symptoms do occur, however, they tend to be related to the organ that has prolapsed. A bladder or urethra prolapse may cause incontinence (leaking urine), frequent or urgent need to urinate or difficulty urinating. A prolapse of the small or large bowel (rectum) may cause constipation or difficulty defecating. Some women may need to insert a finger in their vagina and push the bowel back into place in order to empty their bowels. Women with uterine prolapse may feel a dragging or heaviness in their pelvic area, often described as feeling ‘like my insides are falling out.’

If you have any of the symptoms of prolapse, particularly if you can see or feel something near or at the opening of your vagina, make an appointment to see your health care provider. Many women with prolapse avoid going to the doctor because they are embarrassed or afraid of what the doctor might find, but prolapse is very common and is nothing to be ashamed of. It may be difficult at first to talk about your symptoms, and some women find the examination uncomfortable, but it only takes a few
minutes and, by having your symptoms checked, you are taking an active role in your health and well-being.

Questions to ask your doctor about your prolapse:

  • What type of prolapse do I have?
  • What treatment/surgery do you recommend and why?
  • What if I choose not to have any treatment?
  • What can I do to ease the symptoms?

What to expect at your appointment:
You will be asked about any signs or symptoms. Remember, you don’t have to be nervous; we talk about
these problems every day. Also, your doctor will need to do a thorough pelvic examination. You may be asked to cough or strain during the examination. This enables the doctor to see if any urine leaks or if any of the pelvic organs prolapsed into the vaginal walls. If you have bowel symptoms the doctor may need to feel for bowel prolapse, asking you to strain or bear down. A good doctor will explain what he is doing throughout the examination, but if you have any questions, ask for an explanation.

Treatment Options

Most of the time, treatment will require a surgical procedure or a combination of surgical procedures to re-support the pelvic floor and surrounding structures. Often referred to as anterior (bladder), posterior (rectum) and enterocele (top of vagina), these surgeries are most often performed vaginally. Hospital stay is usually limited to one overnight stay, with many patients going home the same day! After discharge, patients can resume simple daily activities immediately. Patients can typically drive in a week and return to work in two to three weeks. However, your recovery should be individualized for your particular situation.

If you feel like you suffer from any of these conditions or have any questions regarding your gynecological health, please feel free to contact Dr. Don Wilson and/or one of his partners at The Jackson Clinic, Dept of OB/GYN , 731-660-8300.

Dr. Don Wilson is a board certified Obstetrician/Gynecologist at The Jackson Clinic.

With more than 25 years of surgical experience, having performed over a thousand vaginal repair surgeries, Dr. Wilson is one of the highest qualified, pelvic organ prolapse surgeons in the Southeastern United States.

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