anal prolapse

Anal prolapse: description

Anal prolapse usually takes place in stages. First, there is only one incident of the anal canal during heavy pressing on the toilet. After the bowel movement, the anal canal retreats. In the course of it comes with cough or large lifting efforts to an incident on the anus.

If the Analprolaps not treated, it comes after some time to constantly hanging out the anal canal. The disease can progress even further, so that not only the anal canal, but even parts of the rectum and rectum emerge from the anus. One then speaks of a so-called rectal prolapse or rectal prolapse.

Medically, this is a gaze diagnosis: If only a few skin wrinkles have come out of the anus, it is an anal prolapse. However, if there is more to be seen and if all mucous membrane bulges have occurred, this is a rectal prolapse. In the latter case, as a rule, the occlusion function of the anus is no longer present and the defecation can no longer be controlled.

The earlier an anal prolapse is detected and treated, the better the chances of recovery and the lower the potential risks. An anal prolapse is rarely life-threatening, but often represents a severe impairment of quality of life.

Although anal prolapse can occur at any age, it is more common in older people. Mostly a weak pelvic floor muscle is responsible. The anal prolapse can also be signs of other diseases. In any case, the Analprolaps must be treated medically, as he does not heal on his own.

Anal prolapse symptoms

The anal prolapse differs in its complaints from other diseases of the anus. Pain is usually absent or only mild. In contrast, hemorrhoids or anal fissures often present much greater pain. Because of this, pain intensity is often an important feature in the patient talk. Those affected complain more about the large mass of the anus and about the existing incontinence and sometimes about itching.

The incontinence has different severity depending on the extent of the prolapse. In anal prolapse, it is usually not as pronounced as in a rectal prolapse. In addition, the exposed intestinal mucosa constantly produces fluid, so patients feel incontinence is constantly wet. Also it can come to bleeding of the mucous membrane.

The longer the patient waits until final therapy, the more severe the symptoms become. When describing the symptoms, it is also important whether the anal prolapse spontaneously withdraws, or can be pushed back into the anus with the finger. This gives an indication of the severity of anal prolapse and plays a role in the treatment decision.

Anal prolapse: causes and risk factors

The causes of anal prolapse are very diverse. An important role is played by weak pelvic floor muscles. This is therefore also an important starting point in therapy and aftercare.

Although anal prolapse can occur at any age, older people are more likely to be affected. In adults, more than eight out of ten patients are women. In children, an anal prolapse is less common, but here the risk is the same for boys and girls. Children are affected, it usually comes to an anal prolapse before the third year of life, usually even in the first year of life of the child. In children, there is often another cause of illness, such as cystic fibrosis.

In adults, a general sinking of the pelvic floor is often the cause, so that other organs, such as the uterus or the bladder can occur. For example, the birth process can cause damage to the pelvic floor, increasing the risk of anal prolapse in old age.

Certain factors increase the likelihood of anal prolapse. High defecation pressure and constipation can cause a rectal prolapse. In most cases, the muscles of the pelvic floor are too weak to prevent the intestine from falling out. The following factors increase the risk additionally:

• Neurological damage of the nerves in the pelvis
• Injuries to the sphincter
• Gynecological procedures
• Congenital malformations
• inflammation
• tumor diseases

Other diseases can lead to anal prolapse. Prior to any surgical procedure, the entire rectum must be thoroughly examined to rule out further conditions that may have caused anal prolapse or need to be followed during surgery. Ulcers or tumors, as well as polyps can play an important role in the development, as well as a surgical procedure.

Anal prolapse: examinations and diagnosis

Anal prolapse is a gaze diagnosis for a clinically experienced doctor. Already when viewing and palpating an anal prolapse can be distinguished from a rectal prolapse. Ultrasound examinations and reflections can confirm the suspicion and help to estimate the extent better. The reflection of the lower part of the intestine is used especially to clarify the treatment options.

If the incontinence, as well as the degree of anal prolapse can not be estimated, a so-called defecogram can be made. In this case, stool is excreted under fluoroscopy. However, this examination, which is very unpleasant for the patient, is not the rule and is only used for special questions.

Further blood tests and examinations can provide information about the patient’s other health status and thus play a role in estimating the risk of surgery.

Anal prolapse: treatment

The treatment of anal prolapse is usually an operation. Only in rare cases can an OP be omitted. For children, surgery is usually unnecessary. Here is a consistent treatment of the underlying disease (such as cystic fibrosis) usually the best therapy of anal prolapse.

There are many different approaches and techniques to the surgeries. In order to be able to choose the most suitable technique for the respective patient, one must consider the affected person holistically with all his illnesses and problems. Basically, one differentiates between two different surgical methods: The doctor performs the procedure either through the abdominal cavity or from the anus:

• Interventions via the abdominal cavity are performed either via an abdominal incision (laparotomy) or a laparoscopy (laparoscopy). The doctor fixes the rectum so that he can no longer auszubacken. He sews the intestine at the level of the sacrum (rectopexy), in some cases a plastic net holding the intestine in the desired position. Sometimes, the surgeon needs to remove a certain section of the colon (sigmoid section) to tighten it.
• In an operation from the anus, the doctor removes the leaked intestine. He pushes the two ends of the intestine back and sewn them again.

Overall, the risk of recurrence of anal prolapse is lower in the abdominal cavity, but there is a greater risk of complications during or after surgery.

If the surgeon does not cut the abdominal wall, but only operates on the anus, the surgical risk for the patient is lower. However, the long-term chances of success are also lower. Depending on the constitution of the patient, it is therefore necessary to weigh the advantages and disadvantages of the various interventions.

After the operation, the patient must be careful with medications and certain nutritional plans that the stool stays soft and that there are no high pressures in the lower abdomen. It is also often necessary to take antibiotics to prevent infections.

Disease course and prognosis

Anal prolapse is only life threatening in rare cases. The intestine can be pushed back as a rule, and there is no jamming. If this happens, in rare cases an emergency operation is necessary to prevent the death of the fallen out intestinal section.

In all other cases, there is no emergency and the patient can introduce himself in the surgical clinic and, after a detailed explanation with the surgeon, choose the best procedure for him.

Particularly in younger patients, the intervention on the abdominal wall is increasingly chosen, whereas in older people, the risk of such a major surgery is usually too high. After successful intervention is the anal prolapse usually fixed. Patients should now pay attention to a balanced diet, prevent constipation early and strengthen the pelvic floor through exercise. Some clinics offer special courses to learn appropriate exercises to strengthen the pelvic floor muscles.