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Prolapse literally means "to fall out of place". In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is used for organs protruding through the vagina or the rectum or for the misalignment of the valves of the heart. A spinal disc herniation is also sometimes called "disc prolapse".

Relating to the uterus, prolapse condition results in an inferior extension of the organ into the vagina, causing weakened muscles.

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Arbiter definition

Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole.

Rectal Prolapse

Rectal prolapse is a condition in which part of the wall or the entire wall of the rectum falls out of place. In some cases, the rectum may stick out of the body (protrusion).

There are three types of rectal prolapse.

  • Partial prolapse - The lining of the rectum falls out of place while straining to have a bowel movement. Sometimes this displacement is confused with an internal hemorrhoid (which may itself prolapse).
  • Complete prolapse - The entire wall of the rectum falls and usually sticks out of the body. This type of prolapse may occur during bowel movements, but may also potentially occur while walking or standing. Rarely, the tissue may remain constantly remain outside the body.

Partial and complete prolapses may be able to be pushed back inside the body. The prolapse is then said to be reduced (pushed back inside).

  • Internal prolapse (intussusception) - Part of the wall of the colon (large intestine) may slide into or over another part, much like the moving parts of a telescope. The tissue does not hang out of the body; hence, an internal prolapse.

There are multiple causes of rectal prolapse. A lifelong habit of straining to have bowel movements, stresses involved in childbirth, weakening of the anal sphincter muscle, and/or weakening of the tendons that support the rectum are frequent causes. Neurological problems, such as spinal cord transaction or a spinal cord disease, can also lead to prolapse. In rare cases there may be a genetic predisposition. In most cases, though, no single cause can be identified.

Symptoms of a rectal prolapse may be:

  • Leakage of stool
  • Bleeding, anal pain, itching, irritation
  • Tissue that protrudes from the rectum

Other accompanying symptoms may be:

  • A feeling of having full bowels and an urgent need to have a bowel movement
  • Passage of many very small stools
  • A feeling of not being able to empty the bowels completely

Treatment should be aimed at avoiding constipation and avoiding straining to have a bowel movement. A diet rich in fiber and drinking 6 to 8 glasses of decaffeinated fluids every day will assist in keeping stools soft. In some cases physical therapy with biofeedback can assist with avoiding straining. If anal sphincter muscles are weak, Kegels are recommended. Physical therapy can also help strengthen weakened ligaments and anal sphincter muscles.

Two types of surgery are used to treat a complete prolapse. A surgeon may operate through the belly to secure part of the large intestine or rectum to the inside the abdominal cavity (rectopexy). Sometimes the surgeon removes the affected part of the intestine.

Surgery also can be done through the perineum (the area between the genitals and the anus) to remove the prolapsing tissue.

Surgery is most often successful for people who still have some control over their bowel movements. If the anal sphincter is damaged, surgery may correct the prolapse but not be able to completely correct fecal incontinence (lack of control of bowel movements). Fecal incontinence can both potentially improve or worsen after prolapse surgery.

If the lining has fallen out of the anus and is around 7 cm or less, it should eventually retract back inside naturally, though the retraction can take up to 96 hours (4 days).

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the female pelvic organs fall from their normal position, into or through the vagina. Occurring in women of all ages, it is more common as women age, particularly in those who have delivered large babies or had exceedingly long pushing phases of labor. Smoking, obesity, connective tissue disorders, upper respiratory disorders and repetitive strain injuries can all increase prolapse risk. Minor prolapse can be treated with exercises to strengthen the pelvic floor muscles; more serious prolapse, e.g. complete procidentia, requires pessary use or reconstructive surgical treatment. Reconstructive pelvic prolapse surgery may be done without resorting to complete hysterectomy by hysteropexy, the re-suspension of the prolapsed uterus. Traditional gynecologic practice favors removal of the uterus and/or ovaries at the time of prolapse surgery, and one estimate states that of the 600,000 hysterectomies done in the United States every year, 13% are done for prolapse.[1] However, there is concern that many of these hysterectomies may be unnecessary and that hysteropexy would suffice as a treatment instead.

The rectum or urinary bladder may also prolapse as a result of changes in the integrity of connective tissue in the posterior or anterior vaginal walls, respectively. Symptoms may include a feeling of pressure in the pelvis, or the visible protrusion of organs from the vagina. Prolapse is almost never painful, but the change in position of organs may cause urinary or bowel symptoms.

In birds

An egg-bound budgerigar hen with a prolapsed vagina and her mate

Oviduct prolapse is an often fatal condition in birds. When an egg is laid, the vagina everts through the cloaca to deliver the egg. Large eggs and avian obesity are contributors to this condition. Immediate veterinary assistance is paramount to the survival of a bird with prolapse. Even with immediate medical intervention the chances for survival are usually uncertain. Untreated birds will begin to tear at the injury site, and other flockmates will begin to cannibalize the prolapse area, a behaviour commonly known as pickout.

In cattle

Uterine prolapse in cattle, particularly dairy cattle, generally occurs in the first 12 hours post-calving.[citation needed] Frequent causes are hypocalcemia combined with irritation of the birth canal, causing straining. Replacement of the protrusion, which can range from the size of a softball to the hanging of the entire uterus down below the hocks, is performed with the cow in sternal recumbency, an epidural injection, and hindlimbs 'frogged' rearwards to allow the pelvis to tip forward, easing replacement.[citation needed] Careful washing and cleaning prior to replacement is important as is ensuring that the horns are completely everted once inside the cow. Often a Buhner suture is placed in the vulva to prevent subsequent re-prolapse.

In sheep

Same as in cows.

In pigs

Rectal prolapse is a condition routinely identified in pigs on farms and at slaughterhouses. If not reduced quickly, prolapses in pigs become necrotic and infected, and risk being cannibalized by other pen mates. If the latter happens it normally results in death of the animal by septicemia, shock or faecal peritonitis.

In horses and mules

Rectal prolapse occurring in horse and mule would be better termed anal prolapse, as it only involves mucous membrane moving posteriorly to form a circular protrusion outside the anus [2] The condition is not painful.

In mares after parturition, it is described as a 10 to 60 mm mucous protrusion. [3].

In young mules and foals, anal prolapse occurs with a frequency similar to that of Gasterophilus haemorrhoidalis. In extensive breeding conditions, the disease is only recognized after some days, leading to intense edema of prolapsed tissues and necrosis of the mucous membrane.

Early cases in should be treated with the application of hygroscopic substances like powdered sugar followed by purse-string suturing. When prolapsed tissues are edematous and necrotic, amputation is performed. The prognosis is fair as the removes tissues do not contain any important organs or large blood vessels.

References

  1. ^ "Vaginal rejuvenation: sounds great. What is it?". Beautycallbooks.com. http://www.beautycallbooks.com/publications.htm. Retrieved 2009-12-14. mirror
  2. ^ The Merck Veterinary Manual, 3rd ed. Merck and co. Inc. Rahway, N.J., USA, 1967
  3. ^ V.L. Tharp, in Cattcott E.J. & Smithcors J.F. Equine Medicine and Surgery, American Veterinary Publications Inc., 2nd ed 1972, Frebch traduction Vigot Frères, Paris, France, 1974, ISBN 2-7114-0653-0.

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