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Rectal prolapse
Classification and external resources
ICD-10 K62.3
ICD-9 569.1
OMIM 176780
DiseasesDB 11189
eMedicine med/3533
MeSH D012005

Rectal prolapse normally describes a medical condition wherein the walls of the rectum protrude through the anus and hence become visible outside the body.[1]

Contents

Types

There are three chief conditions which come under the title rectal prolapse:

  • Full-Thickness rectal prolapse describes the entire rectum protruding through the anus.[2]
  • Mucosal prolapse describes only the rectal mucosa (not the entire wall) prolapsing.[3]
  • Internal intussusception wherein the rectum collapses but does not exit the anus.[4]

Causes

Rectal prolapse is caused by the weakening of the ligaments and muscles that hold the rectum in place. In most people, the anal sphincter is weak. Rectal prolapse is often associated with the following conditions: advanced age, long term constipation, long term straining during defecation, receiving anal sex,[5][6][7] long term diarrhea, high gastrointestinal helminth loads, pregnancy and stresses of childbirth, previous surgery, cystic fibrosis, COPD, and sphincter paralysis.

Progression

The condition of Rectal prolapse, a type of rectal rupture, undergoes progression: beginning with prolapsation during bowel movements, through Valsalva movements (sneezing and so forth), then through daily activities such as walking until finally it may become chronic and ceases to retract.

Treatment

Partial prolapse may be treated by a diet high in fiber.[8]

Pharmaceutically, the condition may only be treated secondarily (by treating deficate) so as to avoid further straining.

The alternative is surgery. It may be divided into two forms of procedure: abdominal surgery and perineal surgery.

  • Abdominal surgery - for younger patients, but is more dangerous[9]
    • Anterior resection
    • Marlex rectopexy
    • Suture rectopexy
    • Resection rectopexy
  • Perineal surgery - often performed on older patients and is less dangerous[9]
    • Anal encirclement
    • Delorme mucosal sleeve resection
    • Altemeier perineal rectosigmoidectomy
    • Hemorrhoidectomy
  • Children are treated with linear cauterization

Recently, robotic-assisted surgery has been introduced as a treatment option.[10]

Notes

Because most sufferers are elderly, the condition is generally under-reported.[11] The condition can also occur in children.[12]

References

  1. ^ Altomare, Donato F.; Pucciani, Filippo (2007). Rectal Prolapse: Diagnosis and Clinical Management. Springer. p. 12. ISBN 978-8-8470-0683-6. 
  2. ^ Altomare, Pucciani (2007) p.14
  3. ^ Altomare, Pucciani (2007) p.44-45
  4. ^ Diehl, Anna (2005). Advanced therapy in gastroenterology and liver disease. PMPH-USA. p. 521. ISBN 978-1-5500-9248-6. 
  5. ^ Turell, R. (Apr 1974). "Sexual problems as seen by proctologist.". N Y State J Med 74 (4): 697-8. PMID 4523440. 
  6. ^ Essential Revision Notes in Surgery for Medical Students By Irfan Halim; p139
  7. ^ Hampton, BS. (Jan 2009). "Pelvic organ prolapse.". Med Health R I 92 (1): 5-9. PMID 19248418. 
  8. ^ http://www.webmd.com/digestive-disorders/tc/rectal-prolapse-treatment-overview
  9. ^ a b Tjandra, Joe Janwar; Clunie, Gordon J. A.; Kaye, Andrew H.; Smith, Julian (2006). Textbook of surgery. Wiley-Blackwell. p. 247. ISBN 978-1-4051-2627-4. 
  10. ^ Heemskerk J, de Hoog DE, van Gemert WG, Baeten CG, Greve JW, Bouvy ND (November 2007). "Robot-assisted vs. conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time". Dis. Colon Rectum 50 (11): 1825–30. doi:10.1007/s10350-007-9017-2. PMID 17690936. 
  11. ^ "Professional Guide to Diseases". Lippincott Williams & Wilkins. 2008. p. 294. ISBN 978-0-7817-7899-2. 
  12. ^ Saleem MM, Al-Momani H (2006). "Acute scrotum as a complication of Thiersch operation for rectal prolapse in a child". BMC Surg 6: 19. doi:10.1186/1471-2482-6-19. PMID 17194301.& PMC 1785387. http://www.biomedcentral.com/1471-2482/6/19. 

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