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External rectal prolapse may give symptoms of obstructed defecation syndrome, fecal incontinence, or both, [17] [6] Other symptoms are bloody or mucous rectal discharge. [6] Relative indications are: Internal rectal prolapse (rectal intussusception), if it causes symptoms. [20] Anterior rectocele, if large and causing symptoms. [5]
Severe cases may cause vaginal bleeding, intermittent fecal incontinence, or even the prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus. Digital evacuation, or, manual pushing, on the posterior wall of the vagina helps to aid in bowel movement in a majority of cases of rectocele.
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. [2] However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved.
Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions into the vagina. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. [ 2 ]
Cul-de-sac hernias may be classified as rectal, septal, or vaginal depending on the structure they herniate into. Rectal cul-de-sac hernias herniate into an internal or external rectal prolapse. Septal cul-de-sac hernias herniate into the recto-vaginal septum (rectovesical septum in males). Vaginal cul-de-sac hernias bulge into the vagina itself.
Severe cases of hemorrhoidal prolapse will normally require surgery. Newer surgical procedures include stapled transanal rectal resection (STARR) and procedure for prolapse and hemorrhoids (PPH). Both STARR and PPH are contraindicated in persons with either enterocele or anismus .
Rectopexy is a surgery for rectal prolapse. [3] A newer version of the procedure is termed ventral mesh rectopexy, which has also been used for SRUS. [ 14 ] It may be performed with or without anterior resection (removal of a portion of the front wall of the rectum). [ 9 ]
Pessaries are most commonly used for pelvic organ prolapse and considered a good treatment option for women who need or desire non-surgical management or future pregnancy. [12] It is used to treat prolapse of uterine , vaginal wall ( vaginal vault ), bladder ( cystocele ), rectum ( rectocele ), or small bowel ( enterocele ).