Rectal prolapse

Rectal prolapse

We are talking about prolapse (relaxation) of the rectum (the lower part of the large intestine) in women when the rectum protrudes into the vagina (rectocele).
It is a benign common pathology, which although it can be impressive and possibly scare the woman, does not have any serious impact on her health.

Stages

Depending on the degree of rectal prolapse, the projection may be limited to the interior of the vagina (1^st degree), reach the vulva (2^nd degree), or project externally outside the vulva (3^rd degree).

Rationale

It occurs mainly in older multiparous women with a history of total hysterectomy and is due to “relaxation” of the pelvic tissues.
It is estimated that 1 in 9 women, during her lifetime, will undergo a total hysterectomy and of these 10% will present symptomatic pelvic floor prolapse.

Symptoms

The fact that a woman has prolapse does not necessarily mean that she also has symptoms. he may not even be aware of it and be diagnosed by chance during a routine exam at her gynecologist, or have difficulty defecating. If it is more prolapsed, then the woman may feel a feeling of fullness low in the vagina, or see something like an “egg” projecting out of the vagina, often at the end of the day.
In some cases, minor bleeding may occur due to the friction of the mucous membrane with the underwear.

Treatment

The treatment depends on the woman’s discomfort, how much it affects her quality of life, the degree of prolapse and her age.
There is no pharmaceutical treatment since the problem is purely mechanical, so we are oriented towards a conservative solution, such as the placement of vaginal rings.

Vaginal pessaries are rings usually made of silicone, which are placed in the office intravaginally by the gynecologist (no kind of anesthesia is required). In this way, the externalized organs are held in place temporarily.

A more radical and permanent solution is, of course, the surgical restoration of the prolapse.
The colporrhaphy (posterior) technique is the classic technique for restoring prolapse of the female pelvic organs. But since the pathology of prolapse is due to tissue relaxation, the results of this technique depend significantly on the quality of the patient’s tissues. The looser the tissues, the higher rates of prolapse recurrence occur postoperatively. It is estimated that up to 50% of women who undergo surgery with this technique will experience a recurrence of the prolapse in the following years.
Nevertheless, it is widely applied worldwide, mainly in older women and in cases where rectal prolapse is isolated and not accompanied by uterine prolapse.
A more specialized technique is the laparoscopic repair of the rectal prolapse using a mesh (rectopexy), which however has the disadvantage of possible erosion of the rectum, albeit to a small extent.
In any case, the woman whose daily life is affected by organ prolapse should consult her gynecologist, as there are solutions that can significantly improve her quality of life.