American Medical Association Family Medical Guide - American Medical Association [509]
Rectal prolapse
In a rectal prolapse, the lining of the rectum protrudes outside the anus.
Symptoms and Diagnosis
In its earliest stages, rectal prolapse may not be evident outside the body. The first symptoms may be fecal incontinence (see right) and a discharge of mucus or blood from the rectum. You may have some discomfort, but rectal prolapse rarely causes pain. The most obvious symptom is the protrusion of the rectum from the anus, especially when straining during a bowel movement.
A rectal prolapse is diagnosed with a procedure called a defecogram, in which an X-ray video is taken of the rectum while a person has a bowel movement.
Treatment
Treatment of a rectal prolapse depends on the person’s age and general physical condition and on the severity of the prolapse. Rectal prolapse in children usually corrects itself with a high-fiber diet. In adults, a surgeon may implant a band of elastic, wire, or nylon around the muscle of the anus to enable it to support the rectum and keep it in place. Rectal surgery also may involve raising and repositioning the rectum or removing tissue from the rectum. More extensive surgery involves opening the abdomen and removing the displaced segment of the rectum. Surgery is not always successful, and rectal prolapse frequently recurs.
Fecal Incontinence
Fecal incontinence is the inability to retain stool (feces) in the rectum. Fecal incontinence may be caused by damage to the muscles or nerves of the anal sphincter or rectum, diarrhea, lack of elasticity of the walls of the rectum, or dysfunction of the pelvic floor. Damage to the muscles or nerves can occur during childbirth, especially if the doctor uses forceps or does an episiotomy (see page 533). Surgery of the anus or rectum (such as to treat hemorrhoids; see page 778) can also damage the sphincter. Straining during a bowel movement or having a stroke (see page 669) or another disorder that affects the nerves, such as diabetes (see page 889) or multiple sclerosis (see page 696), can also cause fecal incontinence. Having rectal surgery, radiation therapy (see page 23), or an inflammatory bowel disease (see page 764) can cause scarring that makes the walls of the rectum stiff—the rectum can’t stretch and hold the usual amount of stool. Fecal incontinence can also be a consequence of rectal prolapse (see left).
Diagnosis
If you have fecal incontinence, your doctor will perform a physical examination. He or she may also order a series of tests such as manometry (see page 751) to check the tightness of your anal sphincter and the function of your rectum, an ultrasound (see page 111) to evaluate the structure of the anal sphincter, and electromyography to test for nerve damage. The doctor may perform a procedure that measures how much stool your rectum can hold and how well it holds and eliminates stool. During a procedure called sigmoidoscopy (see page 144), the doctor will examine your lower intestine and rectum to look for signs of disease such as inflammation, growths, or scarring.
Treatment
The treatment of fecal incontinence depends on the cause. Your doctor may recommend changes in your diet and eating habits such as avoiding particular foods (for example, caffeine relaxes the anal sphincter muscle), eating small meals more frequently, eating foods with more fiber, and drinking lots of water to avoid dehydration. Your doctor also may prescribe medications such as vitamin supplements and antidiarrheals. Exercises to strengthen the pelvic muscles (Kegel exercises; see page 874) or training the bowels to empty at a particular time of day can be helpful. Because constant contact with stool can cause anal skin inflammation, use the tips on page 778 to soothe irritated anal tissue. If fecal incontinence is the result of injury to the pelvic floor, rectum, or anal sphincter, surgery may be necessary to repair the damage. Some people who have chronic fecal incontinence decide, after discussing it with their doctor, to have a colostomy