Rectal Prolapse
Anatomical causes of constipation
Some patients will find that chronic constipation is stemming from a mechanical defect in their lower gastrointestinal tract. One such disorder is known as the rectal prolapse, one of the common causes of constipation.
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Definition of a prolapse
A prolapse is a general term indicating a condition in which an organ has fallen out of place. This may happen because of injury of underlying tissue, or weakening of the muscles which hold the organ in place. Rectal prolapse refers particularly to the case where the lining of the rectum sags. The rectal tissue may protrude slightly through the anal opening. There is no great cause for alarm, but the condition should be treated immediately. Treatment can even be done at home. Without treatment, observation and care, the prolapsing condition can worsen. Fully prolapsed organs may require surgery for complete repair. If the prolapsed rectum is not visible, it is known as an internal rectal prolapse.
Reducing the chances of another prolapse
There does not seem to be any surefire way to prevent internal rectal prolapses, but some suggest that excessive straining during passage of stool is one cause. Constipation may be a precondition symptom which leads to straining, in turn which is something suspected to be one of the causes of constipation. On the other hand, it is possible that a prolapsed rectum causes a physical obstruction in the path of the stool, which results in difficulty passing stool and reports of conspitation. A group known as the Cochrane Collaboration has also found from analyses of past studies, that Kegel exercises of the pelvic floor muscles may have a protective effect against prolapse of pelvic organs. However, full research has not yet been done on what seems to be a promising new direction of therapy.
Constipation treatments for prolapses
When the prolapsed condition is relatively benign, the constipation treatment strategies are initially very conservative. The physician, or the patient, can use a hand with sterilized gloves to shift the tissue back into place. Surgery at this stage may do more harm than good. Patients are generally given high-dose insoluble fiber therapy, as well as laxatives or constipation medication. All agents will have the attendant effect of relieving constipation as well as pressure on the prolapsed organ. A method known as "biofeedback" has been advocated within the last 10 years to treat internal prolapse. You can read more about biofeedback as a constipation treatment here.
Surgery: pros and cons
Surgery is really a last option for rectal prolapse causes of constipation. In fact, this course of treatment is considered somewhat controversial, with sides for and against it. If the organ is in complete prolapse, surgery becomes a more acceptable option. Worse yet, there is no clear consensus on how a surgeon should proceed with such surgery. Some groups adovcate a surgical path through the abdomen, whereas others advocate a perineal repair approach. This is indicated for elderly patients who do not tolerate abdominal surgery as well as young people. Finally, the prolapsed tissue may be restored via either reshaping of the tissue so that it does not fall, or suturing the tissue to other tissue more securely.
Sources:
Andromanakos et al, Constipation of anorectal outlet obstruction: Pathophysiology, evaluation and management, Journal of Gastroenterology and Hepatology, 2006; 21:638-646