Rectal Prolapse Treatment in Shyamoli

Rectal prolapse is a condition in which the lower part of the large intestine (the rectum) loses its normal anatomical attachments to the pelvic sacrum and slides downward, turning inside-out and protruding through the anal opening. It occurs across all age groups, but is most frequently diagnosed in women over 50 years of age, women with a history of multiple vaginal births, and individuals with decades of chronic constipation and straining.

At Alliance Hospital Limited in Shyamoli, Dhaka, our multidisciplinary Colorectal & Biofeedback Center offers complete diagnostic and therapeutic pathways for rectal prolapse. Combining high-resolution anorectal manometry diagnostic testing, specialized pelvic floor biofeedback muscle rehabilitation, and modern minimally invasive laparoscopic rectopexy, our senior surgical team delivers personalized, long-term restoration of bowel function.

Types of Rectal Prolapse: Partial vs. Full-Thickness

Differentiating the exact degree of prolapse is critical for selecting the correct medical or surgical intervention:

• Mucosal (Partial) Prolapse: Only the inner lining (mucosa) of the rectum slides through the anal canal, often mistaken for protruding Grade 4 internal piles. Concentric mucosal folds are typically absent.
• Full-Thickness Rectal Prolapse (Procidentia): The entire wall of the rectum, including all muscular layers, inverts and protrudes through the anus. It displays characteristic concentric circular rings of mucosal tissue and can measure from 2 cm to over 10 cm in length.
• Internal Intussusception (Occult Prolapse): The rectal wall collapses and telescopes internally into itself during straining, but does not emerge externally through the anal sphincter. This causes severe obstructed defecation syndrome (ODS).

Clinical guidance from the National Health Service (NHS) on rectal prolapse notes that untreated full-thickness prolapse progressively stretches the anal sphincters, leading to severe, irreversible fecal incontinence if surgical fixation is indefinitely postponed.

Common Symptoms of Rectal Prolapse

1. A Visible Red Mass Protruding from the Anus: Initially, the tissue emerges only while straining on the toilet and retracts spontaneously. Later, it requires manual reduction with the fingers, and in advanced stages, it remains continuously externalized even when standing or walking.
2. Mucus and Blood Staining: The externalized rectal mucosa rubs against underclothing, resulting in constant gelatinous mucus discharge and microscopic bleeding.
3. Fecal Incontinence and Incomplete Evacuation: Chronic stretching of the pudendal nerves and anal sphincter causes accidental leakage of liquid stool or gas, accompanied by an uncomfortable sensation of incomplete bowel emptying.
4. Pelvic Dullness and Dragging Sensation: A constant feeling of deep pelvic heaviness or pressure in the lower pelvis.

Advanced Diagnostic Workup at Alliance Hospital

To accurately assess sphincter competence and pelvic floor dynamics, Alliance Hospital utilizes specialized diagnostic technology as reviewed in our clinical guide to comprehensive colorectal dysfunction and diagnostic testing:

• High-Resolution Anorectal Manometry: Evaluates resting and squeeze pressures of the internal and external anal sphincters and measures rectal sensory thresholds.
• Pelvic Floor Examination: Carried out in a private setting by senior colorectal surgeons such as Prof. Dr. Md. Touhidul Islam or Dr. Ismat Jahan Lima to evaluate associated rectoceles, cystoceles, or perineal descent.
• Colonoscopy: Recommended in patients over 45 to rule out underlying polyps, strictures, or colorectal neoplasms triggering chronic straining.

Treatment Modalities: Biofeedback vs. Surgery

1. Non-Surgical Pelvic Floor Biofeedback Therapy

For patients with internal intussusception (occult prolapse), mild mucosal prolapse, or post-surgical pelvic weakness, biofeedback therapy is an extraordinarily effective, non-invasive treatment. By utilizing visual and auditory electromyography (EMG) sensors, our clinical physiotherapists retrain the puborectalis and pelvic diaphragm muscles to relax appropriately during defecation, ending the chronic straining cycle without surgery.

2. Abdominal Laparoscopic Rectopexy

For fit adult patients with full-thickness procidentia, laparoscopic ventral mesh rectopexy represents the gold-standard surgical approach. Through tiny keyhole incisions, the surgeon frees the mobilized rectum and suspends it securely to the promontory of the sacrum using a biocompatible mesh. This restores normal anatomical pelvic positioning, eliminates external protrusion, preserves autonomic pelvic nerves, and significantly improves fecal continence with minimal post-operative pain.

3. Perineal Procedures for Elderly or High-Risk Patients

In frail elderly patients who cannot safely undergo general anesthesia for abdominal surgery, perineal procedures (such as Delorme’s or Altemeier’s perineal rectosigmoidectomy) are performed directly through the anal opening under spinal or regional anesthesia, avoiding abdominal incisions entirely.

Frequently Asked Questions (FAQ)