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Prolapsed Hemorrhoids With Rectal Prolapse

Rectal prolapse is a condition in which the rectum falls downwards and turns inside out. Initially, the rectum stays inside the body, but as the condition worsens, it may protrude outside through the anus. There is often weakness of the anal muscles, which may result in leakage of mucus or stool.

Incomplete rectal prolapse involves the abnormal protrusion of rectal mucosa through the anus. There is a partial overlap of this diagnosis with chronic prolapsed hemorrhoids, especially if part of the prolapse is hemorrhoids, and part of the tissue is rectal mucosa. If the protrusion of rectal mucosa is only partial, then this is called a partial mucosal prolapse.

A great majority of patients are completely relieved of symptoms, or are significantly helped, by the appropriate treatment. Rectal prolapse is most often a chronic condition, and can usually be reduced with the patient recumbent with gentle manual pressure. Patients should minimize their time sitting at commode, and should be maintained on a suitable stool softener pending specialty assessment.

Management of incomplete rectal prolapse in adults is similar to that of hemorrhoids. Treatment includes injection sclerotherapy, mucosal banding, or surgical restoration and plastic repair of the anus and rectum. Occasionally anal sphincter repair is required.

Procidentia in children usually can be corrected by conservative measures. These include: a nutritious diet, avoiding straining at stool, and immediate replacement of the bowel after each protrusion to avoid swelling and possible difficulty in reduction. Children frequently "outgrow" the disease as the natural curve of the sacrum becomes more concave, and surgery may not be needed.

Injections of' sclerosing agents such as 5% phenol in almond oil in the hollow of the sacrum have helped many patients with procidentia. These injections, however, should only be done by a person experienced in this procedure.
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