A prolapse is a protrusion of some part of the bowel through and outside the anus. It may occur in childhood or in the elderly. The cause is not know, but there are many possible explanations. It may occur after excessive straining on defecation, pelvic floor muscle weakness or poor fixation of the rectum in the pelvis.t is six times more common in females, but is not necessarily relayed to childbirth.
The symptoms start as a protrusion during defecation, and later may progress to the protrusion at any time. Initially it can be pushed back in, but as it progresses it may become impossible to push back. There may be pain, or minor leakage, mucous, bleeding or major leakage and incontinence.
The condition is usually diagnosed by physical examination and inspection. If the prolapse is not present at the time, your doctor may ask you to strain on the toilet to produce the prolapse, or may organise to examine you under anaesthetic. This may be done at the same time as a colonoscopy, to rule out other colonic pathology. If symptoms of incontinence are also present, test to assess the anal muscle may also be organised.
Treatment depends on the degree of prolapse, the general health of the patient, what surgery they may have previously had, and the expertise and preference of the surgeon.
For minor (internal) prolapse bulking agents and biofeedback may be all that is necessary. The operations available are performed by the anus, or “perineal procedures”, or through the abdomen, or “abdominal procedures”. These may be open, laparoscopic or robotically performed.