Rectal Prolapse

Introduction

Rectal prolapse is a medical condition where the rectum falls out of its usual position in the pelvic region. The condition can lead to the leaking of stool from your rectum as there is no control of bowel movement. Rectal prolapse is more prevalent in older women, although it can affect both women and men at any age. Vaginal delivery and multiple births are some of the risk factors that may predispose risk of rectal prolapse. While rectal prolapse may sound like a scary condition, it is rarely treated as a medical emergency. Nonetheless, rectal prolapse gets worse with time. It can also be a source of embarrassment. Therefore, the sooner you get treated, the better for your overall improvement in quality of life.

Symptoms of rectal prolapse

Rectal prolapse presents with the following symptoms:

• A red mass that sticks out of the rectum
• Feeling a bulge outside the rectum
• Bleeding from the anal opening
• Leak of poop, mucus or blood from the anus
• Pain in the rectum or anus

Causes of rectal prolapse

Rectal prolapse can be due to several causes, including:

• A history of constipation
• Past injuries to your hip or anal region
• Nerve damage due to complications while giving birth, impairing the ability to loosen or tighten
• Spinal injury or sphincter paralysis

Types of rectal prolapse

Rectal prolapse falls under three main categories:

• Complete prolapse: This is also known as external prolapse. Here, a section of your rectum wall descends and appears to be sticking out from your anus. Initially, the part of the wall is visible only while having a bowel movement. However, as the condition advances,  you are likely to experience a prolapse while walking or standing. In some patients, the prolapse remains external to the body at all times
• Partial prolapse: This type of prolapse is also referred to as mucosal prolapse. Here, it is only the lining of your rectum that descends. The rectum lining will only be visible from the anal opening as you strain during a bowel movement. Children aged 2 and below are more likely to present with partial prolapse. At times, a partial prolapse might look like hemorrhoids.
• Internal prolapse: This kind of rectal prolapse is also referred to as incomplete prolapse. A section of the rectum wall slides over another part of your rectum. Unlike the other two types – partial or complete prolapse, here the prolapse does not protrude from you anal opening. Children are more predisposed to developing internal prolapse.

Treatment options

Although rectal prolapse may not pose a great danger to your health, it is important to seek treatment to avoid getting embarrassed. The condition tends to get worse with time and may lead to other complications such as a permanent damage to the anal sphincter.  The choice of treatment is determined by the type of prolapse. Treatment may entail dietary modification, medication, or surgery.

Home remedies

Home treatment for prolapse may help to avoid the prolapse from coming back. With a child, you may push the prolapse back as soon as it appears

• For children, use a potty to avoid straining during a bowel movement
• For adults, it is possible to push the protruding prolapse back in place as long as the doctor has said its okay to do so
• Make sure you take a lot of vegetables and fruits to avoid constipation. Increase your intake of fluids and in particular, water to assist with improvement in bowel movement
• Dietary changes can reverse partial prolapse
• Exercises such as Kegel exercises are also helpful in strengthening pelvic muscles
• Make sure you are not straining as you have a bowel movement.

Homeopathy

Examples of homeopathic treatment for anal prolapse include:

• Ignatia: This kind of homeopathic treatment is preferred in case of rectal prolapse accompanied by soft stool even as the hard stool remains intact. Ignatia is also recommended when the prolapse manifests in sharp pain that radiates upwards. Moreover, such pain tends to exacerbate following the passage of stool.
• Podophyllum: This homeopathic treatment is ideal for prolapse that manifests as pain in the anus. It is also ideal for patients with chronic constipation. The pain felt while passing stool might cause anxiety in the patients and podophyllum also helps to manage such anxiety.
• Aesculus Hippocastanum: This homeopathic medicine is especially useful in treating chronic piles that can lead to prolapsed rectum. The patient experiences pain in their rectum . There is also a radiating pain around the anus. If a woman has rectal prolapse either during menopause or after menopause, Aesculus Hip is the drug of choice. Such individuals are likely to experience a swelling sensation around the anal region. Moreover, passing stool becomes a painful experience.
• Ruta Graveolens: Ruta is an effective homeopathic cure for mothers who experience the condition during childbirth. Such individuals may be suffering from constipation, thereby making it difficult to make a bowel movement. The pain exacerbates with the sitting position. The medicine is more effective when the rectum descends as one tries to bend or stoop.  

Allopathy

If you are suffering from rectal prolapse that is accompanied by constipation, your doctor may prescribe a stool softener. This will make it easier for you to pass stool without straining.

Procedures/methods available under surgery

The main surgical procedures to treat rectal prolapse are:

Laparotomy:

This is also known as open abdominal surgery. During this procedure, the surgeon makes an incision in your abdomen. The surgeon proceeds to pull the protruding prolapse back in place. The surgeon will then anchor the rectum to the pelvis wall using a mesh sling or sutures. It may be necessary for the surgeon to remove part of your colon, especially if you have a history of constipation.

Laparoscopic rectal prolapse surgery:

This is a form of keyhole surgery. The surgeon makes several incisions on your abdomen These will aid the surgeon in inserting the laparoscope to help in repairing the rectal prolapse. A laparoscope is a surgical instrument with a tiny camera to enable the surgeon to clearly view the inside of your abdomen. Some surgeons are now using robotic technology to perform this procedure. Laparoscopy is characterized by a quicker recovery in comparison with open surgery

Anal surgery:

The procedure takes place under general anesthesia. The surgeon makes an incision around your anal region. This will permit in pulling out the prolapsed bowel. Thereafter, the surgeon repairs any damages to the structure of the bowel. The next activity is to rejoin the bowel with the anus. This helps to restore the bowel appearance and function.

Laser prolapse surgery:

This is a painless procedure that uses laser treatment. The procedure is minimally invasive and there is no bleeding involved. Moreover, laser prolapse surgery takes only about 45 minutes. There are no stitches involved. The procedure is also characterized by excellent postoperative outcomes.

When to go for surgery

You may have to consider surgery for rectal prolapse under the following conditions:

• If all the other treatment options have failed
• In case there is the risk of your sphincter muscles getting damaged

Your decision on where to go for surgery to treat rectal prolapse will depend on several factors, including:

• Surgeon’s fees: This can form a significant portion of the cost of surgery. It is important to check with the different healthcare providers and get to know their fees
• Surgeon’s experience: Surgeons with many years of experience are more likely to conduct the procedure safely, and also effectively manage potential complications. However, such surgeons are also likely to be in high demand. This might mean you will have to wait longer to schedule them for surgery
• Convenience: You are likely to prefer a healthcare facility that you can easily access such as one that is located near where you live. Additionally, you will be mostly interested in a healthcare facility that offers rectal prolapse within your budget
• Health insurance: Most health care insurance will cover rectal prolapse surgery. It is important to check with your healthcare provider just to be sure

Surgery options

Some of the alternatives for rectal prolapse surgery include:

Small clinics

There are many well equipped clinics across India that offer affordable rectal prolapse surgery. One of the benefits of having surgery at small clinics is convenience. The ability to have the procedure near where you live,means that you need not incur any huge transport cost. Another benefit of having surgery at a small clinic, is the familiarity of the location, as well as doctors, which helps to alleviate the anxiety that usually accompanies a surgical procedure.

Besides, you are more likely to receive personalized care and attention at a small clinic than at a large hospital. Also, the waiting time for the surgery is less than what it would be at a large facility. However, small clinics may be limited in terms of the equipment needed to perform rectal prolapse surgery. Also, small clinics may lack recuperating facilities just in case you will need to get admitted for a certain duration after surgery.

Hospitals

We have numerous large private and public hospitals that offer rectal prolapse surgery across India. One of the advantages of having surgery at a large hospital is that the cost of surgery is likely to be less than the what it will be in small clinics. This is because large hospitals attend to hundreds of patients each week and as such  their operations costs are widely distributed. In the case of public hospitals, they receive funding from the government and as such, their costs for surgery are heavily subsidized.

However, you are more likely to wait for longer to undergo surgery at a large hospital, than a small clinic. This is because large hospitals attend to emergency surgeries from time to time. Also, you may not receive personalized care at large facilities than  you would at a small clinic.

Cost of rectal prolapse surgery at different setups

The cost of rectal prolapse surgery in Indian varies depending on the type of rectal prolapse, the facility where you have surgery, and the surgeon’s skill. In Bangalore, laparoscopic rectal prolapse surgery costs between Rs. 1,50,000 and 2,00,000. Other cities like Mumbai and Chennai charge much less. In Mumbai, you can expect to pay Rs. 2000 or more as consultation fees for rectal prolapse.

Post-op care and things to keep in mind

• Your surgeon may recommend you remain in the healthcare facility for some time after surgery so that you can recover. The duration spent at the healthcare facility is determined by the surgical procedure that you underwent. With laser surgery for example, you may only spend a few hours at the healthcare facility. This will also help the healthcare team to further observe your progress. During this period, you can also regain your bowel functions.
• You will be advised to start with drinking clear liquids only. Thereafter, you may start taking solid foods.
• You should also include fiber-rich foods in your diet, such as fruits and vegetables. This will help to overcome constipation. A fiber-rich diet is also helpful as you do not have to strain excessively while having a bowel movement. If you are still straining, there may be a recurrence of prolapse. A stool softener may also be helpful.
• Most patients resume their normal activities after a few weeks post-surgery. In the case of laser surgery, you can resume your daily activities within one week of surgery.
• You may also need to integrate physical therapy such as pelvic floor exercises. However, avoid engaging in strenuous activities such as lifting heavy objects until you have fully recovered.

At goficure, we always commit to high quality and affordable surgical services to treat rectal prolapse. Our team is in touch with leading specialists and can get you an appointment at a discount. We also make travel arrangements to have you picked from home on the day of your surgery. We will also arrange for your transport back home after your discharge from hospital. goficure further assists in filling all the paperwork involved for your surgery, including processing the insurance.

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