Upper Rectum Prolapse

Upper rectum prolapse refers to the slipping or falling down of the upper portion of the rectum, a condition where the rectal tissues lose their support and descend from their usual place. This can cause various symptoms like discomfort, constipation, and the feeling of incomplete bowel movements. In this article, we’ll dive into the structure of the rectum, what prolapse means, its types, causes, symptoms, diagnostic tests, treatments, prevention methods, and frequently asked questions.

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Anatomy of the Rectum (Structure, Blood Supply, Nerve Supply)

The rectum is the last part of the large intestine, responsible for storing and controlling the release of stool. It is about 12-15 cm long and lies just above the anus.

Structure:

• Rectal Layers: The rectum has three main layers: the mucosa (inner lining), submucosa (middle layer with blood vessels and nerves), and muscularis (outer muscle layer).
• Location: The upper part of the rectum is located deep in the pelvis, connected to the sigmoid colon above, and the lower part leads to the anal canal.

Blood Supply:

• Superior Rectal Artery: Main artery supplying the upper rectum, which comes from the inferior mesenteric artery.
• Middle and Inferior Rectal Arteries: They also contribute to the blood supply.

Nerve Supply:

• Sympathetic Nerves: From the hypogastric plexus, responsible for controlling the muscles of the rectum.
• Parasympathetic Nerves: From the pelvic splanchnic nerves, involved in relaxing the rectal muscles to allow bowel movements.

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Types of Rectal Prolapse

1. Full-Thickness Prolapse: The entire wall of the rectum slides down and protrudes out of the anus.
2. Mucosal Prolapse: Only the inner lining (mucosa) of the rectum slips and protrudes.
3. Internal Prolapse (Intussusception): The rectum folds into itself but doesn’t protrude outside the body. This commonly occurs in the upper rectum.

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Causes of Upper Rectum Prolapse

1. Chronic Constipation: Straining during bowel movements weakens rectal tissues.
2. Pregnancy and Childbirth: Stress on pelvic muscles.
3. Aging: Loss of muscle tone in the pelvic floor with age.
4. Obesity: Excess weight puts pressure on the rectum.
5. Chronic Diarrhea: Persistent bowel movements may weaken the rectum.
6. Pelvic Floor Dysfunction: Weak muscles that support the rectum.
7. Previous Rectal Surgery: Surgery can weaken tissue support.
8. Neurological Conditions: Nerve damage, such as from spinal cord injuries, can lead to prolapse.
9. Ehlers-Danlos Syndrome: A connective tissue disorder.
10. Chronic Cough: Conditions like chronic obstructive pulmonary disease (COPD) can lead to prolapse due to constant pressure.
11. Heavy Lifting: Excessive strain on pelvic and abdominal muscles.
12. Cystic Fibrosis: This can increase intra-abdominal pressure, leading to prolapse.
13. Multiple Deliveries: Vaginal deliveries can increase the risk.
14. Hysterectomy: Removal of the uterus may weaken pelvic support.
15. Collagen Vascular Diseases: These can weaken connective tissue.
16. Constipation from Medications: Some drugs can cause chronic constipation.
17. Spinal Injuries: Loss of nerve function to the pelvic floor.
18. Pelvic Radiation: Damages tissues that support the rectum.
19. Colorectal Cancer: Tumors may cause the rectal wall to weaken.
20. Chronic Prostatitis: In men, ongoing inflammation of the prostate may lead to prolapse.

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Symptoms of Upper Rectum Prolapse

1. A feeling of a bulge: Sensation of tissue coming out of the rectum.
2. Constipation: Difficulty in passing stool.
3. Incomplete bowel movements: Feeling that the bowels haven’t fully emptied.
4. Rectal bleeding: Blood may appear due to irritation of the prolapsed tissue.
5. Rectal pain: Discomfort or pain in the rectum.
6. Mucus discharge: Mucus may come out from the rectum.
7. Fecal incontinence: Inability to control bowel movements.
8. Rectal pressure: A sense of fullness or pressure in the rectal area.
9. Urinary problems: Difficulty in urinating or frequent urination.
10. Anal itching: Itching sensation around the anus.
11. Difficulty passing gas: Difficulty controlling gas due to weakened muscles.
12. Straining: Having to strain significantly during bowel movements.
13. Prolapsed tissue: Visible or palpable tissue outside the anus.
14. Low back pain: Pain due to pressure on the pelvic area.
15. Frequent bowel movements: Needing to go to the bathroom more often.
16. Rectal heaviness: A feeling of heaviness in the pelvic region.
17. Fatigue: General tiredness due to the discomfort of the condition.
18. Pain during sex: In some cases, prolapse may cause discomfort during intercourse.
19. Difficulty sitting: Discomfort when sitting down for long periods.
20. Feeling of obstruction: A sensation of blockage during bowel movements.

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Diagnostic Tests for Upper Rectum Prolapse

1. Digital Rectal Exam: The doctor checks for prolapse by feeling inside the rectum.
2. Defecography: X-ray that shows how the rectum works during bowel movements.
3. Colonoscopy: A tube with a camera is inserted to check for abnormalities in the rectum.
4. Anorectal Manometry: Tests the strength of rectal muscles.
5. MRI Scan: Provides detailed images of the rectum and pelvic organs.
6. CT Scan: Cross-sectional images of the rectum and surrounding structures.
7. Proctoscopy: A camera is inserted into the rectum to inspect the inner lining.
8. Balloon Expulsion Test: Tests how well you can pass a balloon inflated in the rectum.
9. Endoanal Ultrasound: Images of the anal canal to check for muscle damage.
10. Pelvic Floor EMG: Tests the function of pelvic floor muscles.
11. Barium Enema X-ray: X-ray of the colon and rectum after barium is inserted.
12. Pelvic MRI Defecography: MRI test to observe pelvic organ function during defecation.
13. Rectal Biopsy: Tissue sample taken from the rectum for analysis.
14. Anal Sensation Test: Evaluates nerve response in the anal area.
15. Pelvic Floor Ultrasound: Checks for structural abnormalities in the pelvic floor.
16. Cystoscopy: Checks the bladder for issues that may accompany rectal prolapse.
17. Transrectal Ultrasound: Ultrasound through the rectum to examine tissues.
18. Pelvic Organ Prolapse Quantification: Measures the extent of organ prolapse.
19. Abdominal X-ray: Examines the abdomen and rectal area.
20. Electromyography (EMG): Evaluates the electrical activity of muscles involved in defecation.

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Non-Pharmacological Treatments for Upper Rectum Prolapse

1. Pelvic Floor Exercises (Kegels): Strengthen the muscles around the rectum.
2. Dietary Fiber: Increase fiber intake to ease bowel movements.
3. Hydration: Drink plenty of water to prevent constipation.
4. Biofeedback Therapy: Helps improve control over bowel movements.
5. Stool Softeners: Over-the-counter remedies to make passing stools easier.
6. Avoid Straining: Minimize pressure on the rectum during bowel movements.
7. Postural Changes: Adjusting sitting posture while on the toilet to reduce pressure.
8. Warm Baths: Helps relax rectal muscles and relieve discomfort.
9. Use of Squatty Potty: Changes the angle of defecation, making it easier.
10. Yoga: Improves muscle tone in the pelvic floor area.
11. Regular Exercise: Walking, swimming, or light aerobic exercises to strengthen muscles.
12. Pelvic Floor Physical Therapy: A specialized therapist helps with muscle training.
13. Reduce Heavy Lifting: Minimize activities that increase abdominal pressure.
14. High-Fiber Supplements: Psyllium or methylcellulose supplements to prevent constipation.
15. Avoid Long Toilet Sitting: Reduce time sitting on the toilet to prevent strain.
16. Perineal Massage: Helps relieve rectal pressure.
17. Laxatives (Natural): Use of natural laxatives like prune juice for constipation relief.
18. Acupuncture: Helps with chronic pain and muscle relaxation.
19. Avoid Prolonged Coughing: Treat conditions like COPD or chronic bronchitis.
20. Behavioral Modification: Changing daily habits to avoid constipation.
21. Electrical Stimulation: Strengthens pelvic muscles using electric pulses.
22. Postural Training: Learning to maintain proper body posture.
23. Rectal Supports: Temporary devices to support the rectum.
24. Sitz Baths: Sitting in warm water to reduce inflammation.
25. Breathing Techniques: Prevents straining during bowel movements.
26. Avoid Heavy Meals: Eating smaller, more frequent meals.
27. Deep Breathing: Helps with relaxation of rectal muscles.
28. Leg Elevation While Lying: Reduces pressure on the rectum.
29. Use of Mild Enemas: Helps relieve constipation.
30. Probiotic Foods: Yogurt or kefir to promote digestive health.

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Drugs for Upper Rectum Prolapse

1. Stool Softeners (Docusate): To ease bowel movements.
2. Bulk-Forming Laxatives (Psyllium): Help bulk up stool for easier passage.
3. Osmotic Laxatives (Polyethylene Glycol): Draws water into the stool.
4. Stimulant Laxatives (Bisacodyl): Stimulates bowel contractions.
5. Prokinetic Agents (Prucalopride): Improves bowel motility.
6. Topical Creams (Hydrocortisone): For rectal itching or irritation.
7. Antispasmodics (Hyoscyamine): Reduces bowel spasms.
8. Opioid Antagonists (Methylnaltrexone): Helps with constipation from opioids.
9. Antidiarrheal Medications (Loperamide): To manage diarrhea.
10. Pain Relievers (Acetaminophen): For discomfort relief.
11. Suppositories (Glycerin): Lubricates the rectum for easier bowel movements.
12. Probiotic Supplements: To improve gut health and prevent constipation.
13. Topical Anesthetics (Lidocaine): Numbs rectal pain.
14. Antibiotics (Metronidazole): To treat infections associated with prolapse.
15. Fiber Supplements (Citrucel): Helps with bowel regularity.
16. Stimulant Laxatives (Senna): Stimulates bowel activity.
17. Anti-inflammatory Suppositories: Reduces inflammation in the rectum.
18. Corticosteroid Creams: Reduces swelling and irritation.
19. Mild Sedatives: To ease anxiety related to prolapse symptoms.
20. Herbal Remedies: Such as aloe vera or slippery elm for gut health.

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Surgeries for Upper Rectum Prolapse

1. Rectopexy: Surgery to fix the rectum in its proper position.
2. Laparoscopic Rectopexy: A minimally invasive form of rectopexy.
3. Perineal Rectosigmoidectomy (Altemeier Procedure): Removes the prolapsed section through the anus.
4. Delorme Procedure: Removes only the inner layer of the prolapsed rectum.
5. Mesh Rectopexy: Uses a mesh to hold the rectum in place.
6. Sigmoid Resection: Removes part of the sigmoid colon in combination with rectopexy.
7. Suture Rectopexy: Uses stitches to secure the rectum.
8. Transanal Proctosigmoidectomy: Removes the prolapsed part through the anus.
9. Posterior Vaginal Repair: For women with both rectal and vaginal prolapse.
10. Stapled Rectal Prolapse Surgery: Staples are used to fix the prolapse.

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Prevention Methods

1. Maintain a High-Fiber Diet: Prevent constipation by eating fruits, vegetables, and whole grains.
2. Stay Hydrated: Drink plenty of water to keep stools soft.
3. Pelvic Floor Exercises: Regularly strengthen pelvic muscles.
4. Avoid Heavy Lifting: Minimize activities that strain the abdomen.
5. Lose Excess Weight: Maintain a healthy weight to reduce pressure on the rectum.
6. Avoid Straining on the Toilet: Don’t force bowel movements.
7. Treat Chronic Cough: Get treatment for conditions like COPD or bronchitis.
8. Address Chronic Diarrhea: Seek medical advice to control diarrhea.
9. Regular Bowel Habits: Go to the bathroom when you feel the urge, don’t delay.
10. Exercise Regularly: Stay active to maintain muscle tone and digestive health.

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When to See a Doctor

• Persistent or worsening symptoms: If you feel constant discomfort, or see tissue protruding from your anus, it’s time to seek medical advice.
• Bleeding or severe pain: Rectal bleeding or intense pain may indicate a serious condition.
• Inability to control bowel movements: If you lose control of your bowel movements, contact your doctor.
• Chronic constipation or diarrhea: If these issues persist for a long time, get medical help.
• Visible prolapse: When tissue is visibly coming out of the anus, it’s crucial to consult a specialist.

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Frequently Asked Questions (FAQs)

1. What is rectum prolapse?
   • It occurs when part of the rectum slips out of its usual position, either internally or externally.
2. Can rectal prolapse heal on its own?
   • In some mild cases, lifestyle changes may help, but more severe cases often require medical treatment.
3. Who is at risk of upper rectum prolapse?
   • Elderly people, women who’ve had multiple vaginal deliveries, and those with chronic constipation.
4. Is rectum prolapse a common condition?
   • It’s not very common but can occur in people with weak pelvic muscles.
5. Can I prevent rectal prolapse?
   • Yes, with a healthy diet, pelvic floor exercises, and avoiding constipation.
6. What are the main symptoms of upper rectum prolapse?
   • A feeling of fullness in the rectum, discomfort, and sometimes visible protrusion.
7. How is rectum prolapse diagnosed?
   • Through a combination of physical exams and imaging tests like defecography.
8. Can rectal prolapse be life-threatening?
   • While not usually life-threatening, it can cause significant discomfort and complications if untreated.
9. What non-surgical treatments are available?
   • Dietary changes, pelvic exercises, and avoiding straining can help.
10. When is surgery necessary?
    • When non-surgical treatments fail or if the prolapse worsens.
11. What lifestyle changes can help with rectal prolapse?
    • Eating fiber-rich foods, staying hydrated, and doing pelvic exercises.
12. Can pregnancy cause rectal prolapse?
    • Yes, pregnancy and childbirth can increase the risk due to pressure on the pelvic muscles.
13. Are there complications after rectal prolapse surgery?
    • Complications can include infection or recurrence, but these are generally rare.
14. What happens if rectal prolapse is left untreated?
    • It can lead to worsening symptoms, pain, and issues with bowel control.
15. How long is recovery after surgery?
    • Recovery time can vary, but most patients can resume normal activities within a few weeks.

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This guide provides a thorough understanding of upper rectum prolapse, its causes, symptoms, diagnosis, and treatment. By following preventive measures and seeking early medical intervention, you can manage this condition effectively. Always consult with a healthcare provider for the best advice tailored to your specific needs.

 

 

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.