Anal Prolapse: Causes, Symptoms, and Treatment Options

Anal protrusion issue?

Hello, Dr.
Ke! Previously, I had an anal fissure and noticed a protrusion at the 12 o'clock position of the anus.
During my follow-up visit, the doctor said the fissure had healed, but this anal protrusion has not resolved, even with topical treatments.
It especially becomes enlarged during bowel movements, and when pressed, it feels swollen and slightly painful.
After a bowel movement, it takes about an hour of performing anal sphincter exercises for the swelling to reduce somewhat, which is quite inconvenient.
I wonder if it is possible to have it surgically removed in an outpatient setting? How long does it typically take for the wound to heal? It seems that only external hemorrhoids have outpatient surgical options, and I'm not sure about this situation.
I would appreciate it if you could take some time to clarify this for me.
Thank you!

Mark, 40~49 year old female. Ask Date: 2016/05/15

Dr. Ke Fangxu reply Surgery

Anal polyps caused by anal fissures do not disappear, even after the fissure has healed.
The healing of the anal area is related to medication use and bowel habits.
If proper care is taken, along with warm sitz baths, the wound can heal in about a week.
However, it is common for symptoms to persist for more than three months.
Traditional surgery for anal fissures requires hospitalization, but there are many outpatient surgical options available that I cannot comment on personally.

Reply Date: 2016/05/15

More Info

Anal prolapse, also known as rectal prolapse, is a condition where a portion of the rectum protrudes through the anus. This condition can be quite uncomfortable and may lead to various symptoms, including pain, discomfort during bowel movements, and a visible bulge around the anal area. Understanding the causes, symptoms, and treatment options for anal prolapse is essential for managing this condition effectively.

Causes of Anal Prolapse
Anal prolapse can occur due to several factors, including:
1. Chronic Constipation or Diarrhea: Straining during bowel movements can weaken the pelvic floor muscles and lead to prolapse.

2. Age: As individuals age, the muscles and tissues supporting the rectum may weaken, increasing the risk of prolapse.

3. Childbirth: Women who have had multiple pregnancies or difficult deliveries may experience pelvic floor weakening.

4. Obesity: Excess weight can put additional pressure on the pelvic floor, contributing to prolapse.

5. Neurological Conditions: Conditions that affect nerve function can impair the muscles that support the rectum.

Symptoms of Anal Prolapse
The symptoms of anal prolapse can vary but typically include:
- A visible bulge or protrusion from the anus, particularly during bowel movements.

- Discomfort or pain in the anal area, especially when sitting or during bowel movements.

- A feeling of incomplete evacuation after a bowel movement.

- Mucus discharge or bleeding from the rectum.

- Difficulty controlling bowel movements.

Treatment Options
Treatment for anal prolapse depends on the severity of the condition and the symptoms experienced. Here are some common treatment options:
1. Conservative Management: For mild cases, lifestyle changes such as dietary modifications to prevent constipation, pelvic floor exercises, and avoiding straining during bowel movements may be recommended.

2. Medications: Topical treatments may help alleviate symptoms, but they may not address the underlying prolapse.

3. Surgical Intervention: If conservative measures fail, surgical options may be necessary. Surgery can involve:
- Rectopexy: This procedure involves securing the rectum to the surrounding tissues to prevent it from prolapsing.

- Resection: In some cases, a portion of the prolapsed rectum may be removed.

Surgical Considerations
Regarding your specific situation, since you mentioned that the anal prolapse has not improved with topical treatments and is causing discomfort, surgical intervention may be a viable option. It is essential to consult with a colorectal surgeon who can evaluate your condition and discuss the best surgical approach.
The recovery time after surgery can vary depending on the procedure performed and individual factors. Generally, patients may experience some discomfort and swelling post-surgery, but most can return to normal activities within a few weeks. It is crucial to follow your surgeon's post-operative care instructions to ensure proper healing.

Conclusion
In summary, anal prolapse can significantly impact your quality of life, and understanding its causes, symptoms, and treatment options is vital. If you are considering surgical intervention, it is advisable to have a thorough discussion with your healthcare provider to weigh the benefits and risks. They can provide personalized recommendations based on your specific condition and overall health. Remember, timely intervention can lead to better outcomes and improved comfort.

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