Anal prolapse

Fabian Dupont is a freelance author in the NetDoktor medical editorial office. The human physician is already for scientific work among others Belgium, Spain, Rwanda, the United States, Great Britain, South Africa, New Zealand and Switzerland. The focus of his doctoral thesis was tropical neurology, but he is particularly interested in international health science (public health) and the comprehensible communication of medical issues.

With one Anal prolapse the anal canal falls out of the anus. In severe cases, anal prolapse results in involuntary leakage of bowel movements and stool (bowel incontinence). People with hemorrhoids and the elderly, especially women, are particularly often affected. Read more about the symptoms and treatment options of anal prolapse.

Brief overview

  • Symptoms:anal canal bulges outward (under pressure)
  • Treatment: Avoid constipation, do not exert excessive pressure during bowel movements, depending on the severity, surgical treatment is recommended
  • Diagnosis:Based on the complaints, eye/touch examination, evtl. Endoscopy of the rectum, X-ray examination
  • Prognosis: Early treatment reduces the risk of complications and worsening of symptoms, usually patients are symptom-free again after surgery
  • Causes: High pressure on intestinal walls in connection with weak intestinal tissue
  • Prevention: Balanced diet for normal bowel movements, avoid constipation, sufficient exercise, early treatment by a doctor

What is anal prolapse?

Anal prolapse usually progresses in stages. At first, prolapse of the anal canal only occurs when affected persons push hard on the toilet. After defecation, the anal canal retracts again. In the further course it comes already with coughing or large lifting efforts to a prolapse at the anus.

It is advisable to have anal prolapse treated. The first point of contact is the family doctor or a proctologist, a specialist in diseases of the rectum. If this is not done, the anal canal hangs out permanently after some time. It is possible for the condition to progress so that not only the anal canal, but even parts of the rectum and rectum protrude from the anus. This is known as rectal prolapse.

You can read more about rectal prolapse in our article Rectal Prolapse.

Doctors usually recognize anal prolapse at first glance, as only a few folds of skin protrude from the anus. Affected persons often also have hemorrhoids. If pronounced hemorrhoids are present, the distinction from anal prolapse tissue is not so easy in some cases. However, if entire mucosal bulges have prolapsed, the condition is no longer anal prolapse, but rectal prolapse.

What are the symptoms of anal prolapse?

Most often, those affected notice that a piece of intestine is turned inside out. For some people, it is only temporary when there is a lot of pressure, such as on the toilet or heavy lifting. In others, the bowel remains permanently turned outward.

Anal prolapse differs in its symptoms from other diseases of the anus. Pain is usually absent or only mildly present. In contrast, sufferers of hemorrhoids or anal fissures often report much more severe pain. This is why pain intensity is an important feature when talking to the doctor.

In some cases there is itching, and in some cases there is bowel incontinence. The degree of incontinence depends on the extent of the prolapse. In anal prolapse, it is usually not as severe as in rectal prolapse. In addition, the exposed intestinal mucosa constantly produces fluid, so that patients have the feeling that they are constantly wet, in addition to incontinence. In some cases, bleeding of the mucosa occurs.

The longer the affected person waits with the therapy, the more severe the symptoms develop. When describing the symptoms, it is also important whether the anal prolapse retracts spontaneously or whether it is possible to push it back into the anus with a finger. This gives an indication of the severity of the anal prolapse and plays an important role in the decision for therapy.

How is anal prolapse treated?

The treatment of anal prolapse depends on its severity. Only in rare cases is it a mild form of anal prolapse that does not require surgery, at least for the time being. In many cases, however, the doctor recommends surgery, especially if incontinence is present. In children, surgery is usually not necessary. In this case, consistent treatment of the underlying disease (such as cystic fibrosis) is usually the best therapy for anal prolapse.

Many people have diseases of the rectum such as hemorrhoids, but are hesitant to talk to doctors or pharmacists about them because they are ashamed – even though the complaints are associated with a very high level of suffering. With the right advice and treatment, these conditions can be managed well in most cases.

Non-surgical treatment options

If the anal prolapse is mild, retracts on its own or can be pushed back, an alternative, non-surgical therapy may be considered. Doctors recommend various measures here to support healthy digestion:

  • Eat enough dietary fiber
  • Keeping the patient adequately hydrated
  • Little sitting
  • Move a lot

At the same time, it is advisable to avoid anything that puts pressure on the rectum, such as heavy lifting or carrying and pushing on the toilet. In addition, various ointments help against pain or itching and cause the tissue to contract again somewhat, as in the case of hemorrhoid treatment.

Surgical treatment options

If the anal prolapse is permanent, associated with suffering and/or incontinence, doctors usually recommend surgical treatment. There are many different procedures and techniques for these. In order to select the most suitable technique for each patient, it is necessary for the doctor to take a holistic view of the patient with all his or her illnesses and problems. Basically, a distinction is made between two different surgical methods:

  • Surgery via the abdominal cavity: Procedures through the abdominal cavity are performed either through an abdominal incision (laparotomy) or a laparoscopy (laparoscopy). The doctor fixes the rectum in such a way that it can no longer sag. It sutures the intestine at the level of the sacrum (rectopexy), although in some cases a plastic mesh holds the intestine in the desired position. Sometimes the surgeon has to remove a certain section of the colon to tighten it (sigmoid resection).
  • Surgery from the anus: In surgery from the anus, the doctor removes the protruding bowel. Then the surgeon pushes back the two ends of the bowel and sutures them together again.

Overall, the risk of a recurrence of anal prolapse is lower when the procedure is performed through the abdominal cavity. However, this surgical method carries a higher risk of complications during or after surgery.

If the surgeon operates through the anus rather than the abdominal wall, the surgical risk for the patient is lower. However, the long-term chances of success are lower. Depending on the patient’s constitution, the advantages and disadvantages of the various interventions must be weighed up.

For the operations, in most cases, the affected person stays in the hospital for a few days. Whether the procedures should be performed under general or partial anesthesia and how long the hospital stay is planned depends on several factors. For example, from what the health condition of the affected person is.

After the operation, the patient must take care with medication and certain diet plans that the stool remains soft and that there is no high pressure in the lower abdomen. Often patients are given antibiotics to prevent infections.

How anal prolapse occurs and are there risk factors?

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

Anal prolapse occurs at any age, although older people are more commonly affected. In adults, more than eight out of ten patients are women. Anal prolapse occurs less frequently in children, but the risk is the same in boys and girls. If children are affected, anal prolapse usually occurs before the age of three, usually even in the first year of the child’s life. In children, there is often another disease as the cause, such as cystic fibrosis.

In adults, it is often caused by a general sagging of the pelvic floor, so that in some cases other organs, such as the uterus or bladder, prolapse as well. Occasionally, for example, the birth process causes damage to the pelvic floor, increasing the risk of anal prolapse in old age.

Certain factors further increase the likelihood of anal prolapse. High defecation pressure and long-term constipation are among the causes for the development of prolapse. In most cases, the muscles of the pelvic floor are too weak to prevent the bowel from falling out. The following factors additionally increase the risk:

  • Hemorrhoids of high severity
  • Neurological damage to the nerves in the pelvis
  • Injuries to the sphincter muscle
  • Gynecological surgery
  • Congenital malformations
  • Inflammation
  • Tumor diseases

Other diseases also lead to anal prolapse. Before any surgical intervention, doctors examine the entire rectum in detail to rule out other diseases that may be causative for anal prolapse or that need to be considered during surgery. Ulcers, tumors and polyps as well as surgical interventions play an important role in the development in some cases.

How anal prolapse is detected?

Anal prolapse is a visual diagnosis for a clinically experienced physician. Anal prolapse can be detected and distinguished from rectal prolapse by examination and palpation. Ultrasound examinations and colonoscopies occasionally help confirm suspicions and better assess the extent of the problem. In order to clarify which treatment options are available, the doctor primarily uses colonoscopy of the lower section of the bowel.

If the incontinence and the degree of anal prolapse cannot be assessed, doctors may suggest a so-called defecogram in rare cases. In this case, the affected person excretes stool under X-ray fluoroscopy. However, this examination, which is very unpleasant for the patient, is not the rule and is only used for special problems.

Further blood tests and examinations provide information about the patient’s other health conditions. This plays a role in assessing the risk of surgery.

What is the prognosis for anal prolapse?

The earlier anal prolapse is detected and treated, the better the chances of recovery and the lower the possible risks. Anal prolapse is only life-threatening in rare cases. The bowel can usually be pushed back, and there is no strangulation. If this does happen, emergency surgery is necessary in rare cases to prevent the death of the intestinal segment that has fallen out.

In all other cases there is no emergency, but anal prolapse is often accompanied by a severe limitation of the quality of life. It is advisable for those affected to present themselves to the surgical clinic. The proctologist or surgeon will then explain the procedure and recommend the best procedure for the individual complaints.

Especially in younger patients, doctors recommend the procedure through the abdominal wall. For older people, they weigh the usually high surgical risk for such a major procedure.

After the operation, the Anal prolapse usually remedied. Nevertheless, it is important that those affected pay attention to the following aspects afterwards:

  • Pay attention to a balanced diet
  • Prevent possible constipation at an early stage
  • Strengthen the pelvic floor through sports

Some clinics offer special courses to learn appropriate exercises to strengthen the pelvic floor muscles.

How to prevent anal prolapse?

There are measures to reduce the influenceable risk factors for anal prolapse. One of the main causes of anal prolapse is high pressure on the rectum. For this reason, it is advisable to pay attention to a balanced diet and healthy digestion. Diarrhea, constipation as well as heavy pressing on the toilet are to be avoided as far as possible.

If regular or permanent problems with digestion occur, it makes sense to consult the family doctor and get help early on. Especially if additionally hemorrhoids are present.

At the same time, there are many factors, such as age, gender or other medical conditions, that increase the risk of anal prolapse, but they cannot be influenced.

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