Have you ever heard of an anal prolapse? Many people answer this question with no. In fact, these anus incidents are very common. We just don’t talk about it. More about symptoms, causes and treatment of anal prolapse.
Doctors speak of an anal prolapse when intestinal mucosa protrudes through the anus. In colloquial language, the disease is also referred to as the anus incident. However, if the end of the rectum is turned outward, it is a rectal prolapse.
Typical symptoms of the anus incident include itching and bleeding. Sometimes there is stool lubrication or incontinence. With anal prolapse, the intestinal mucosa flips outwards, often during a firm bowel movement. The protuberances can also occur spontaneously. Most often, the incidents are a result of advanced hemorrhoids (grades 3-4). Other causes include sphincter weaknesses, pregnancy or pelvic floor weakness. Therapy for anal prolapse is to clear hemorrhoids or to fixate the intestinal mucosa again during a surgical procedure.
Reliable information on the frequency of anal prolapse in Germany is not available. There is a simple reason for this: Most people find it uncomfortable to talk about the disease or to provide information. The disease is often concealed from the doctor.
Experts believe that 70 percent of all people develop hemorrhoids in the course of their lives. They are considered a widespread disease. Men and women are affected approximately equally. The majority of diseases occur after the age of 40. In Germany, about 50,000 people undergo anal prolapse for hemorrhoids each year.
The eponymous symptom of anal prolapse is a prolapse of the rectum through the sphincter (anus). In the event of an anus, the intestinal mucosa emerges from the anus as a flesh-red, swollen and highly perfused tissue in a mostly star-shaped structure. Sometimes, however, only small parts of the mucous membrane or individual folds of mucous membrane get out. Typical accompanying symptoms are painless, severe itching as well as bleeding, inflammation and stool smear.
At the beginning of the disease, the intestinal mucosa automatically slides back into the anal canal. Or those affected press the protuberance back into the intestine with their fingers. In later stages, this is often no longer possible. The prolapse is permanent. Then there is also stool incontinence, so those affected can no longer control bowel movements.
The most common cause of anal prolapse is hemorrhoids. You can find detailed information about their symptoms, causes and therapy in the Hemorrhoids Guide.
Another cause of anus incidents is pelvic floor weakness. If the pelvic floor loses its holding function, internal organs such as the intestine move more towards the exit of the intestine. As a result, an internal intestinal prolapse develops. The intestine folds internally. This leads to bottlenecks – and to the fact that more pressure is necessary to empty the bowels. And this starts a cycle: the harder you press, the more stress is put on the pelvic floor. And the greater the risk of hemorrhoids, anal prolapse or rectal prolapse.
Other important causes of anal prolapse are constipation and misuse of laxatives. Constipated people often press with great pressure. This also applies to people who take laxatives. Because the laxatives impair natural bowel movements and make long-term bowel movements difficult instead of causing them. With the pressure, however, the pelvic floor is further damaged.
Finally, the weight of growing children in the womb also means that the pelvic floor is heavily loaded during pregnancy.
Intestinal diseases and anal prolapse
Bowel diseases such as ulcerative colitis, Crohn’s disease and irritable bowel syndrome are also associated with an increased risk of hemorrhoids and anal prolapse. In addition, colon carcinomas as well as rectal and gynecological interventions favor their development.
Anal prolapse in children
A rare cause of anal prolapse in children is the metabolic disease cystic fibrosis (cystic fibrosis). Congenital malformations of the anus and rectum can also promote anal prolapse.
Experienced urologists or proctologists diagnose anal prolapse mainly based on the typical star-shaped structure of the emerging tissue. To confirm the finding and to rule out serious causes such as carcinoma, an endoscopic examination of the intestinal exit and / or rectum is usually carried out. The ultrasound examination (sonography) of the intestine can also confirm the diagnosis.
If the results are unclear, another diagnostic method is used, the so-called defecogram. In this examination, the patients are X-rayed while they excrete stool. However, this unpleasant procedure is only used in exceptional cases.
In the vast majority of cases, anus incidents require surgery. This operation is done either directly on the anus or through the abdomen. The surgery in the abdominal cavity can be minimally invasive as part of an abdominal mirroring (laparoscopy) or by opening the abdominal wall with a larger incision (laparotomy).
Abdominal anal prolapse surgery
During the operation via the abdominal cavity, the entire intestine is raised to relieve the pelvic floor. So that he does not lower himself again after the operation, different procedures can be considered. In this way the intestine can be fixed to the sacrum. Sometimes a plastic net is used to give the intestine more support. Only with a laparotomy is the bowel sometimes tightened.
Anal prolapse surgery on the anus
In anal prolapse surgery on the anus, the surgeon first removes the part of the intestinal mucosa that has escaped. Then the ends of the intestinal mucosa are pushed back, stapled and sutured.
The healing prospects after anal prolapse are generally considered good. With regard to the surgical procedures, it can be said that the complication and relapse rate after surgery via the abdominal cavity is lower than with surgery on the anus. However, laparoscopy and laparotomy are associated with the greater general risk of anesthesia and surgery.
The most common cause of anal prolapse is hemorrhoids. Prevention of hemorrhoids is therefore the best prophylaxis against anal prolapse. In particular, pressing hard during bowel movements increases the risk. A varied diet with fresh products and sufficient drinking are essential for healthy digestion. They promote soft stools that help prevent excessive pressing. Exercise also stimulates the intestine. This also helps with constipation. You should avoid laxatives. Laxatives are the most common cause of constipation – and thus for heavy pressing with the consequences described.
Targeted pelvic floor training makes sense to strengthen the pelvic floor. The pelvic floor can also be trained in everyday life. To do this, simply tense your muscles when you have the appropriate opportunity (waiting times, for example) as if you wanted to interrupt the urine stream or to hold up your bowel movements.
Every pregnancy is a top performance for the pelvic floor. Therefore women should train their pelvic floor consistently during pregnancy and in the puerperium. Midwives and physiotherapists will inform you about appropriate exercises.