Should You Consider Surgery for Painless Rectal Prolapse?

Q: Should You Consider Surgery for Painless Rectal Prolapse?

Hello： The symptoms you described seem to indicate a hemorrhoid issue. <br>If there is prolapse that does not retract on its own, it suggests a third-degree hemorrhoid or higher, and you should visit a hospital for examination. <br>Additionally, hemorrhoids are related to dietary

If there is a protrusion outside the anus but it is not painful, is surgery necessary?

Hello Doctor: A few years ago, I experienced a protrusion from my anus, but it retracted on its own after about two days.
After three or four years, it happened again, lasting about two weeks, and I eventually had to push it back in manually.
Two years later, while I was preparing for an exam, I was sitting for about ten hours a day or standing for four to five hours at a time.
Near the end of my exam period, the protrusion appeared again.
It is not painful or itchy, but it causes discomfort due to friction while walking, and it has not disappeared after six months.
Even when I push it back in, it still comes out.
I am a vegetarian, so I do not have issues with constipation.
However, I often stay up late and drink coffee, and I used to love spicy food.
I do not have a bathtub where I live, so I have been rinsing with warm water, but it still shows no signs of disappearing.
What should I do, Doctor? Thank you!

Q, 20~29 year old female. Ask Date: 2004/12/21

Dr. Lin Zhemin reply Surgery

Hello: The symptoms you described seem to indicate a hemorrhoid issue.
If there is prolapse that does not retract on its own, it suggests a third-degree hemorrhoid or higher, and you should visit a hospital for examination.
Additionally, hemorrhoids are related to dietary habits: it is advisable to consume less food that is prone to causing heat or dryness, as well as to limit stimulating foods such as alcohol, spicy foods, and those containing caffeine.
Sleep is also closely related: individuals who stay up late are more likely to develop hemorrhoids.
Please take note of these factors and avoid them.
Wishing you health and happiness.

Dr.
Lin Zhe-Min, Surgery, Miaoli Hospital

Reply Date: 2004/12/21

More Info

When considering surgery for painless rectal prolapse, it is essential to weigh the benefits and risks associated with both surgical and non-surgical treatment options. Rectal prolapse occurs when the rectum protrudes through the anus, and while it can be painless, it can lead to discomfort and complications if left untreated.
In your case, it seems that you have experienced recurrent episodes of rectal prolapse over several years, with the most recent episode persisting for six months. Although you do not experience pain or itching, the discomfort from the protrusion and the fact that it does not resolve on its own are significant factors to consider.

Non-Surgical Options
Initially, non-surgical treatments may be recommended, especially if the prolapse is not causing significant symptoms. These can include:
1. Dietary Changes: Since you mentioned that you are a vegetarian and do not have constipation issues, maintaining a high-fiber diet can help ensure regular bowel movements, which may reduce the risk of further prolapse.

2. Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises such as Kegel exercises can help support the rectum and may alleviate some symptoms.

3. Lifestyle Modifications: Reducing prolonged sitting and standing, managing weight, and avoiding heavy lifting can also help minimize the risk of worsening the prolapse.

4. Supportive Devices: Some patients find relief using a pessary, a device inserted into the vagina to support the pelvic organs. However, this may not be applicable in your case, depending on your specific anatomy and comfort.

Surgical Options
If non-surgical methods do not provide relief or if the prolapse continues to affect your quality of life, surgical intervention may be necessary. Surgical options for rectal prolapse include:
1. Rectopexy: This procedure involves attaching the rectum to the surrounding tissues to prevent it from prolapsing. It can be done through an abdominal approach or via a perineal approach, depending on the severity of the prolapse and the patient's overall health.

2. Resection: In some cases, a portion of the rectum may be removed if it is damaged or if there are other complications.

3. Laparoscopic Surgery: Minimally invasive techniques can be employed to reduce recovery time and postoperative pain.

Risks and Considerations
While surgery can be effective in treating rectal prolapse, it is not without risks. Potential complications include infection, bleeding, and recurrence of the prolapse. Additionally, some patients may experience changes in bowel habits or incontinence after surgery. Therefore, it is crucial to have a thorough discussion with your healthcare provider about the potential outcomes and risks associated with surgery.

Conclusion
Given your situation, it may be beneficial to consult with a colorectal surgeon who specializes in pelvic floor disorders. They can provide a comprehensive evaluation and help you determine the best course of action based on your symptoms, lifestyle, and overall health. If surgery is deemed appropriate, they will explain the procedure, recovery process, and expected outcomes, allowing you to make an informed decision.
In summary, while non-surgical options may provide initial relief, persistent symptoms and discomfort may warrant surgical intervention. It is essential to address this issue proactively to prevent further complications and improve your quality of life.

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