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Rectal Prolapse

Disease Details

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Description: Rectal prolapse is a condition where part or the entire wall of the rectum slides out of place, sometimes protruding through the anus, leading to discomfort and potential complications.
Type: Rectal prolapse is primarily a condition caused by weakening of the pelvic floor muscles and support tissues, rather than a genetic disorder. However, familial cases of rectal prolapse have been documented, suggesting a possible genetic predisposition in some instances. The exact mode of genetic transmission in these cases is not well-defined, but it may involve multifactorial inheritance, where a combination of genetic and environmental factors contributes to the condition.
Signs And Symptoms: Signs and symptoms include:

history of a protruding mass.
degrees of fecal incontinence, (50-80% of patients) which may simply present as a mucous discharge.
constipation (20-50% of patients) also described as tenesmus (a sensation of incomplete evacuation of stool) and obstructed defecation.
a feeling of bearing down.
rectal bleeding
diarrhea and erratic bowel habits.Initially, the mass may protrude through the anal canal only during defecation and straining, and spontaneously return afterwards. Later, the mass may have to be pushed back in following defecation. This may progress to a chronically prolapsed and severe condition, defined as spontaneous prolapse that is difficult to keep inside, and occurs with walking, prolonged standing, coughing or sneezing (Valsalva maneuvers). A chronically prolapsed rectal tissue may undergo pathological changes such as thickening, ulceration and bleeding.If the prolapse becomes trapped externally outside the anal sphincters, it may become strangulated and there is a risk of perforation. This may require an urgent surgical operation if the prolapse cannot be manually reduced. Applying granulated sugar on the exposed rectal tissue can reduce the edema (swelling) and facilitate this.
Prognosis: The prognosis for rectal prolapse can vary depending on the severity of the condition and the treatment administered. Generally, with appropriate surgical intervention, many patients experience significant improvement or complete resolution of symptoms. Non-surgical treatments may provide temporary relief but often do not offer a permanent solution. Early diagnosis and treatment can improve outcomes and reduce complications.
Onset: Rectal prolapse is a condition where the rectum protrudes through the anus. Onset can vary based on the underlying cause, but it is more common in older adults, especially women. Contributing factors include chronic constipation, straining during bowel movements, weakened pelvic floor muscles, or previous pelvic surgery. Early symptoms may include a feeling of incomplete bowel evacuation, mucous discharge, and mild incontinence.
Prevalence: The prevalence of rectal prolapse is relatively low, with estimates suggesting it affects approximately 2.5 per 100,000 people. It is more common in women, particularly those over the age of 50.
Epidemiology: Rectal prolapse affects less than 0.5% of the general population. It affects women more commonly, with a female to male ratio of 9:1.
Intractability: Rectal prolapse is generally not considered intractable. It can often be managed and treated effectively with both non-surgical and surgical interventions. Non-surgical treatments may include dietary changes, pelvic floor exercises, and stool softeners to reduce straining during bowel movements. Surgical options can correct the prolapse, especially in more severe cases.
Disease Severity: Rectal prolapse severity can vary from mild to severe. In mild cases, only a portion of the rectal lining may protrude. In more severe forms, the entire rectum can prolapse, extending outside the anus. The severity often dictates the symptoms and the required treatment, ranging from lifestyle changes and medications to surgical intervention.
Healthcare Professionals: Disease Ontology ID - DOID:9307
Pathophysiology: Rectal prolapse involves the protrusion of the rectal wall through the anal opening. The pathophysiology often includes weakening of the pelvic floor muscles and ligaments, which can be due to chronic straining during bowel movements, age-related muscle weakening, or underlying neurological conditions. This weakening leads to the inability of the structures supporting the rectum to maintain its normal position, resulting in prolapse.
Carrier Status: Rectal prolapse is not associated with carrier status as it is not a genetic disorder but rather a condition in which the rectum protrudes through the anus. Factors contributing to rectal prolapse include chronic constipation, straining during bowel movements, weakened pelvic floor muscles, and certain neurological conditions. Treatment may involve lifestyle changes, pelvic floor exercises, or surgery.
Mechanism: Rectal prolapse is a condition where the rectum protrudes through the anus.

**Mechanism:**
The rectum becomes abnormally mobile, often due to weakening or disruption of the pelvic support structures, including muscles and connective tissue. Factors can include chronic straining during bowel movements, previous pelvic surgeries, childbirth, and certain neurological or connective tissue disorders.

**Molecular Mechanisms:**
While the detailed molecular mechanisms of rectal prolapse are not as well characterized as its anatomical aspects, some insights include:

1. **Collagen and Connective Tissue Abnormalities:**
Dysregulation in the synthesis and remodeling of collagen, which provides structural support to the pelvic floor, may contribute to weakened pelvic structures. Abnormalities in types I and III collagen have been implicated.

2. **Neuromuscular Dysfunction:**
Alterations in the signaling pathways that control the pelvic floor muscles can lead to improper muscle function. This might involve neurotransmitter imbalances or receptor dysfunctions that impact muscle strength and coordination.

3. **Genetic Factors:**
Genetic predispositions affecting connective tissue integrity can increase susceptibility to prolapse. This can involve mutations or polymorphisms in genes related to extracellular matrix proteins or their regulatory components.

In summary, rectal prolapse involves both anatomical disruptions and potentially underlying molecular aberrations impacting connective tissue and neuromuscular function.
Treatment: Although SRUS is not a medically serious disease, it can be the cause of significantly reduced quality of life for patients. It is difficult to treat, and treatment is aimed at minimizing symptoms.
Stopping straining during bowel movements, by use of correct posture, dietary fiber intake (possibly included bulk forming laxatives such as psyllium), stool softeners (e.g. polyethylene glycol, and biofeedback retraining to coordinate pelvic floor during defecation.Surgery may be considered, but only if non surgical treatment has failed and the symptoms are severe enough to warrant the intervention. Improvement with surgery is about 55-60%.Ulceration may persist even when symptoms resolve.
Compassionate Use Treatment: For rectal prolapse, potential compassionate use or experimental treatments may include:

1. **Surgical Innovations**: Experimental surgical techniques or minimally invasive procedures not yet widely adopted.
2. **Stem Cell Therapy**: Investigational use of stem cells to strengthen or repair rectal tissues.
3. **Tissue Engineering**: Experimental procedures involving bioengineered tissues to replace or support damaged rectal structures.
4. **Neuromodulation**: Off-label use of devices like sacral nerve stimulators to manage symptoms by modulating nerve signals.

These treatments are generally in clinical trial phases and are not yet approved as standard care.
Lifestyle Recommendations: For rectal prolapse, lifestyle recommendations can improve symptoms and reduce the risk of recurrence:

1. **Dietary Adjustments**:
- **High-Fiber Diet**: Include fruits, vegetables, whole grains, and legumes to soften stool and ease bowel movements.
- **Hydration**: Drink plenty of water to prevent constipation.

2. **Bowel Habits**:
- **Regular Bowel Movements**: Establish a routine for bowel movements, preferably after meals, to take advantage of the body's natural peristalsis.
- **Avoid Straining**: Do not strain during bowel movements as it increases abdominal pressure and may worsen prolapse.

3. **Physical Activity**:
- **Regular Exercise**: Engage in regular physical activity to improve overall health and reduce constipation.
- **Pelvic Floor Exercises**: Strengthening the pelvic floor muscles through exercises like Kegels can improve support for the rectal area.

4. **Weight Management**:
- Manage body weight to reduce unnecessary pressure on the pelvic organs.

5. **Avoid Heavy Lifting**:
- Minimize activities that involve heavy lifting to avoid increasing intra-abdominal pressure.

6. **Posture and Core Stability**:
- Maintain good posture and strengthen core muscles to support the pelvic region.

If symptoms persist or worsen, it's important to consult a healthcare professional for further evaluation and management.
Medication: Rectal prolapse typically requires surgical intervention for definitive treatment. Medications may not directly address the prolapse itself but can help manage symptoms and associated conditions like constipation or inflammation. Stool softeners or laxatives might be prescribed to ease bowel movements and reduce strain. Additionally, if there's inflammation or discomfort, topical treatments or anti-inflammatory medications might be recommended. However, these are adjunct measures and not a cure for the prolapse.
Repurposable Drugs: Rectal prolapse is a medical condition where the rectum protrudes through the anus. Treatment often involves surgical correction, but some medications are used to manage symptoms or coexisting conditions. While there are no specific "repurposable drugs" exclusively indicated for rectal prolapse, certain medications can help manage associated symptoms:

1. **Laxatives and Stool Softeners** (e.g., polyethylene glycol, docusate): To ease bowel movements and prevent straining.
2. **Fiber Supplements** (e.g., psyllium): To promote regular, soft bowel movements.
3. **Prokinetic Agents** (e.g., prucalopride): In cases of chronic constipation, these can help enhance bowel motility.
4. **Topical Agents** (e.g., hydrocortisone creams, anesthetics): To reduce local discomfort, swelling, or inflammation.

Medical management is generally supportive, focusing on symptom relief, while surgical options provide definitive treatment. Always consult a healthcare provider for diagnosis and personalized treatment options.
Metabolites: Rectal prolapse does not have specific metabolites associated with it as it is a structural condition rather than a metabolic disorder. Rectal prolapse involves the protrusion of the rectal tissue through the anus and is primarily related to weakening of the pelvic floor muscles and ligaments. Treatment often focuses on surgical correction, physical therapy, and lifestyle changes rather than addressing metabolites.
Nutraceuticals: There is limited scientific evidence supporting the use of nutraceuticals specifically for the treatment of rectal prolapse. Management usually involves dietary modifications such as increasing fiber intake to prevent constipation, which can exacerbate prolapse. It is important to consult with a healthcare provider for an appropriate treatment plan.
Peptides: For rectal prolapse, peptides have not been widely studied or used as a standard treatment. Current treatments generally focus on surgical intervention and lifestyle modifications rather than peptide therapy. Research is ongoing, but peptides are not a recognized treatment for this condition at this time.