Rectal prolapse
Occasionally, one sees a complication resulting from long-standing constipation and associated laxity of the anal muscles, particularly in elderly, bed-ridden patients. Having to strain causes exertion of high pressure on the rectum.
In younger patients, the pressure from straining often causes the blood vessels in the inner lining of the anus to bulge out. That is called haemorrhoids or piles. In these elderly patients, whose anal control muscles (a.k.a. anal sphincters) are weak, the rectum itself gets pushed out little by little. It may eventually become a full-blown rectal prolapse. Prolapse means a protrusion of an organ outwards from it’s normal position.
See the nice concentric circular pattern of the mucosal folds?
How does one deal with this? Don’t panic. When the pressure is relieved, the rectum usually goes in by itself. However, it sometimes need to be pushed in by the patient or the care-provider.
The prolapsed rectum just needs to be replaced through the anus.
So the question is : how do we prevent it from prolapsing again? First and foremost, improve the consistency of the stool by improving the diet. Thus straining is avoided and the pressure produced is reduced. So, prolapsed is avoided. Secondly, an operation may be performed to resect (cut away) the reduntant (extra, flabby) part of the rectum or hitch it up so that it will not prolapse.
In this elderly, bed-bound patient I opted not to do anything more than give some common-sense dietary advice and prescribe stool bulking agents, like ispaghula husk, to improve the consistency of the stools.
Wah sure or not old lady? Skin looks firm! I had a few cases of these and one was a young man, army officer with this? Why I wonder? Still diet meh? Pictures are somewhere in my thumbdrive!
Parasitic also can what? Not to mention like my young army patient - social reasons?
George, hahaha… perhaps you would like to tell us the story of your army officer too… and his social reason. And trackback from here so that we can go and read it too.
This is an old lady.. i got her to strain to confirm the presence of the prolapse. She couldn’t even squat to do that, she had to lie on her side.
Good grief!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! *pengsans*
Bernard, aiyoh, warn me lah if you showing photos like that. My lunch hour and I am eating and then suddenly, eewwww…..cannot eat already!
LB, are you ok??? *clears an area for fresh air, props LB’s legs up*
Judy, ooppps… sorry about that…. mebbe next time i’ll get you to click for the photos. Sounds fair?
I guess you haven’t been immunised to the type of posts found here… they’ve been very mild over the past week because of the tag-posts and family posts. Hehe.
OK, fixed the psot liao… you guys and girls can come to the blog and can choose whether to see the photos or not… fair enough?
I’ve heard that if you had piles, never, never to get a surgery cos you won’t be able to pass hard or big stool in future. Is it true? Then i have another friend that did the surgery and she can’t pass motion and she get another doc’s (in Melbourne) opinion and had a 2nd surgery. After that only can pansai. Why is that so?
Oh, and I forgot to say this, OMFGGGGGGGGGGGGGGGG, that is huge!!!!! looks like a full bloom flower! eeks….
Bernard, wah sorry lah to inconvenient you..you shouldn’t have gone through all the trouble.
I thought perhaps looking more of these sort of pictures may also cure me of my weak stomach for blood and vomit. Just don’t visit Bernard’s blog when eating. Best time is when I am in jamban or in bed! Hahaha.
No Queen, sometimes haemorrhoids operations can cause a complication of anal stenosis (narrowing). But that is uncommon and avoidable. I can’t comment on your friend’s case because the original surgeon should be the one informing her of what the problem is.
Judy, no trouble… just copy and paste a little bit here and there :-)… I hope you don’t visit your PC when eating. Hahaha.
seems like there is an anatomic rose blooming way down there..Look scary huh.. Btw, I have the tendency to go toilet 4 hours after i had my meal. If go toilet too frequent will I have the same problem?
You see Bernard, Like car engine, if u rev high and go fast, the life span also shorten.
So if i go toilet more frequent, will It become malfunction also?
my Q may be silly but this is what i had daily..
Sigh…..
Poor lady
I hope she really do go for her diet changes
ohhh…*faints*..thank god I already ate! Poor lady!!!!!!
Now..i have to beraks!
Munch… munch.. munch… *indulging nice kaya kok*
Hmm… what’s that big flower thingy? Is it for real?
Bernard, you must put a warnings for people with weak constitutions… *munch munch, dang I’m getting immune to the photos* LOL!
raychin, well… it’s within normal range to open your bowels from 3 times a day to once in three days. There’s nothing to wear and tear when you go to toilet, so it’s not a problem if you go often.
yenjai, her care-givers prepares everything for her… so i guess she’s got no choice.
mott, next time you’re constipated, you can come and look at this again…. it looks like it stimulates “beraks”.
jonzz, *munch munch* want some kacang putih with that?
I welcome the pics as a picture can replace the effect of a thousand words…haha..am I the exception?
Oh sure, and an iced coffee if you don’t mind… *smirk*
I thought I read that one reason for the rectum to protrude is in the use of the squat type of toilet. Prolonged use (ie.. people who like to read newspapers) in that position.. hahaha, wait rectum also like to come out liao.
aiyoh, OMG! that must hurt bad hor?
Okie, Okie, must eat papaya tiap-tiap hari.
At one glance, i thought that’s a blood soaked rolled up bandage push up into the anal….errr…to stop bleeding;…. then, look at it again….OMG!!! (i didnt notice the title ma…)
hmmm… looking at it again. hmmmm….looks like some kind of fruits la.
why the mucosa look so thick?… macam thick skin saje.
just me, you are right.. a pictures speaks a thousand words.
jonzz, sure.. but go to for better kopi… go to the kopitiams… ah soh FH and tauke bengbeng.
LM, straining at stools causes these and piles. Why prolapse happens instead of piles is the laxity/looseness of the anal sphincter in these patients.
nyonyapenang, good idea… hmmmm.. anyone interested in selling papayas online?
CSH, it’s not just mucosal prolapse, it’s the whole thickness of the rectum prolapsed.
Mucosal prolapse is just the inner layer prolapsed out. Here, all layers of the rectum has prolapsed.
A couple of things on my mind when I read this:
a) How does the stool bulking agent like ispaghula husk improve passage of stools?
- the bulk is to reduce separation of stools, in other words, primarily to combine smaller stools?
- I thought once being bulky actually reduces ease of passage
I don’t disagree with the wonders of taking ispaghula husk, just want to know the mechanics on how it works.
b) With the passage of stools in different shapes daily or even on the same visit, again I hope to understand their difference.
For example:
- Why is it sometimes in 20 small chunks of 1 inch sizes and at other times in 2 long piece of 3-4 inches length?
c) Does higher fibre also means increase dryness and hence require more water intake for the colon? I just noticed with sufficient water intake the day before, the next morning passage of stools is relatively cooperative. Again, don’t understand how water intake works in favor of easy stools passage.
Hope you can shed some light. Thanks Bernard.
Milo, bulky doesn’t mean hard, usually the stool is bulky and soft… so it’s easy to sense the presence of stools in the rectum and easy to pass out.
The shapes and sizes depends on the consistency and volume of the stools. I suppose that if there are various shapes and sizes, it means that they came from different batches of the day and were stored together in the sigmoid colon until peristalsis pushed them to the rectum and the sensation to void came about.
When the stools arrive in the colon, they are liquid. Most of the water content in the stools are absorbed in the descending colon and sigmoid colon during storage there. So if the water intake is adequate and the peristalsis is normal… the water content of the stools that enter the rectum will be adequate… ergo, producing soft stools. And hard stools otherwise.
So the key is ’senses of the presence of stools’. I am slowly putting the pieces together from your explanation. Imagine, not even knowing what to ask at times. Sorry if I went round the bushes a couple of times!
My observation so far, non-bulky stools have half-inch diameter while bulky stools have approximately 1 inch diameter.
a) Sometimes it has a length of 2 to 4 inches.
b) Other times, it is just one entire soft lump all mashed together. Can’t make any sense of (b) yet.
Kinda funny (more like second-nature these days), I stool-read (monitor) daily as part of my life-long healthy colon regime. Everything got to start with ourself, I believe. And with a little help from Bernard, I don’t have to feel completely LOST. Thank YOU.
Milo, hahaha… I must credit you for coining the term “stool-reading”… that’s hilarious. You’re welcome to talk about stools anytime.
The actual size varies with individuals but you’re right to identify that the important thing about bulky stools is the sensation of stools.
hahaha…macam can fortune-read
MiloIn a sense, it should be more accurate than reading palms.
I consider Health one of my greatest Fortune. Truly one of those things that cannot be purchased over the shelf or ordered online and arrive in a nice box. Got to work hard on it….
Talk about stool…how to get the “stucked” stool to pass motion when you halfway doing “business”? sometimes when we where about there…there will be a moment when you’re about to done your bisness and you thought “ok here comes the last one”…and it just paused there!!! No matter how I try it still won’t come out and tend to “reverse back”…does this consider constipation? and this had caused my nervous system to tense up coz worry the stool actually know my intention and was trying to be funny with me….!@##%$@$$%^…very stressful…arrrgghhhhh!!!
Xenical pill….
Xenical pill….