Gynaecology (II)
Subtopic:
Pelvic Organ Prolapse (POP)
This condition develops when the pelvic floor muscles and ligaments, which normally provide support to the pelvic organs, become weakened. This lack of support can result in pelvic organs descending or bulging into the vagina.
Categorization: POP is broadly categorized into three main types:
1. Anterior Vaginal Wall Prolapse: This category involves prolapse in the front wall of the vagina.
* Cystocele: The most prevalent form of POP, occurring when the urinary bladder descends and protrudes into the vagina. The severity is graded from 1 to 3:
* Grade 1 (Mild): Slight descent of the bladder into the vaginal canal.
* Grade 2 (Moderate): The bladder descends further, approaching the vaginal opening.
* Grade 3 (Severe): The bladder protrudes significantly through the vaginal opening.
* Urethrocele: Prolapse of the urethra, the tube conveying urine from the bladder, into the vagina.
2. Apical Prolapse: This type involves the apex or top of the vagina.
* Enterocele: Protrusion of the small bowel into the upper region of the vagina.
* Uterine Prolapse: Descent of the uterus into the vagina or beyond. The staging is based on the position of the cervix:
* Stage 0: No prolapse is present.
* Stage 1: The cervix descends but remains more than 1 cm above the hymen.
* Stage 2: The cervix descends to be at, or within 1 cm above or below, the hymen.
* Stage 3: The cervix descends more than 1 cm below the hymen but less than total vaginal length.
* Stage 4: Complete uterine prolapse, also known as procidentia, where the entire uterus is outside the vagina.
* Vaginal Vault Prolapse: Occurs after hysterectomy when the upper portion of the vagina loses its support, leading to sagging or descent into or outside the vaginal canal.
3. Posterior Vaginal Wall Prolapse: This involves prolapse in the back wall of the vagina.
* Rectocele: A bulge of the rectum, the final segment of the large intestine, pushing into the posterior wall of the vagina.
* Rectal Prolapse: A separate condition, distinct from POP, where a portion of the rectum telescopes outwards and protrudes through the anus. It is often confused with hemorrhoids but is not related to pelvic organ prolapse.
Prolapse of the Uterus
Uterine prolapse occurs when the uterus shifts from its normal position within the pelvis and descends into the vaginal canal. This condition arises due to the weakening of the pelvic floor’s supportive structures—muscles and ligaments—that are responsible for holding the uterus in place. This descent can range in severity, with the uterus in some cases protruding outside of the vagina. Uterine prolapse is also medically referred to as descensus uteri or procidentia.
Causes and Contributing Factors:
Uterine prolapse is primarily caused by the weakening or damage of the pelvic floor muscles and ligaments that ordinarily support the uterus and other pelvic organs. Several factors can contribute to this weakening:
Impact of Pregnancy and Delivery:
Vaginal Childbirth: The physical exertion during vaginal delivery, particularly with larger infants, can place significant strain on and weaken the pelvic floor muscles.
Multiple Pregnancies: Each subsequent pregnancy adds cumulative stress, potentially further weakening these supportive muscles.
Age-Related Changes and Hormonal Influence:
Advancing Age: Natural aging processes lead to a reduction in tissue elasticity and overall strength, including within the pelvic floor.
Menopause and Estrogen Decline: The decrease in estrogen levels during menopause can result in the thinning and weakening of pelvic tissues.
Additional Contributing Factors:
Persistent Coughing: Chronic coughs stemming from conditions such as bronchitis or asthma exert repeated pressure on the pelvic floor.
Chronic Constipation: Repeated straining during bowel movements can weaken pelvic floor support over time.
Pelvic Surgical Interventions: Major surgeries in the pelvic region, such as hysterectomies or removal of pelvic tumors, can sometimes compromise the integrity of supporting structures.
Smoking Habits: Smoking is linked to reduced estrogen levels and can negatively affect the elasticity of tissues throughout the body, including pelvic tissues.
Excessive Weight Lifting: Regularly lifting heavy objects can place undue stress on the pelvic floor muscles.
Obesity and Excess Weight: Increased body weight adds extra pressure on the pelvic floor, increasing strain.
Pelvic Tumors (Rare): In rare instances, pelvic tumors can exert pressure or displace the uterus, contributing to prolapse.
Neurological Conditions: Certain conditions affecting the nervous system, such as muscular dystrophy, multiple sclerosis, or spinal cord injuries, can lead to weakness in the pelvic floor muscles.
Family Predisposition: A family history of uterine prolapse may indicate a genetic predisposition and increase an individual’s risk.
Pathophysiological Mechanism:
The pelvic floor muscles and ligaments function as a supportive hammock, providing essential support to the uterus, bladder, and rectum. When these supportive structures become weakened or damaged, they are no longer able to maintain the uterus in its normal position, leading to its descent into the vagina.
Staging of Uterine Prolapse
The degree of uterine prolapse is classified into stages based on the extent of cervical descent:
Stage 1: The cervix descends into the upper portion of the vagina.
Stage 2: The cervix descends further, reaching a position near the vaginal opening.
Stage 3: The cervix protrudes externally, outside of the vaginal opening.
Stage 4: The entire uterus is located outside the vagina, representing complete prolapse.
Clinical Features
Symptoms associated with uterine prolapse can vary widely depending on the severity of the condition. Common presentations include:
Pelvic Pressure or Fullness: A sensation of heaviness or pressure within the pelvic region.
Lower Back Discomfort: Pain experienced in the lower back area.
Protrusion Sensation: A feeling as if something is descending or coming out of the vagina.
Vaginal Bulge: A palpable bulge felt within or protruding from the vagina.
Dyspareunia: Pain or discomfort experienced during sexual intercourse.
Walking Discomfort: Pain or unease experienced during ambulation.
Visible Uterine Tissue: In more advanced cases, uterine tissue may be seen protruding from the vaginal opening.
Altered Vaginal Discharge: Unusual or increased vaginal discharge.
Constipation Issues: Difficulty or reduced frequency of bowel movements.
Recurrent Urinary Tract Infections (UTIs): Repeated episodes of UTIs.
Symptom Exacerbation: Symptoms may worsen with prolonged periods of standing or walking.
Urinary Complaints: Problems with urination such as incontinence (leakage) or urinary frequency.
Bowel Movement Difficulties: Challenges or changes in bowel habits.
Diagnosis
Diagnosis of uterine prolapse typically involves a combination of:
Medical History Review: Gathering detailed information about the patient’s symptoms, medical background, and risk factors.
Physical Examination:
Abdominal Assessment: Examination of the abdomen to evaluate the uterus’s size and position.
Pelvic Examination: Visual and manual examination of the vagina and cervix to assess prolapse.
Bimanual Examination: Internal examination to assess the strength and support of the pelvic floor muscles.
Laboratory Investigations:
Complete Blood Count (CBC), Urinalysis, and Cervical Cultures: May be conducted if an infection is suspected.
Pap Smear or Cervical Biopsy: Performed to rule out cervical cancer or other cervical abnormalities.
Imaging Studies:
Pelvic Ultrasound: Utilized to visualize the uterus and surrounding pelvic structures.
Magnetic Resonance Imaging (MRI): May be employed for detailed staging and to determine the extent of the prolapse.
Differential Diagnoses
It is important to differentiate uterine prolapse from other conditions that may present with similar symptoms, including:
Urinary Tract Infection (UTI) or Cystitis: Infections of the urinary tract or bladder can mimic prolapse symptoms.
Early Gestation: The early stages of pregnancy can cause pelvic pressure and a feeling of fullness.
Pelvic Neoplasms: Tumors or growths in the pelvic region can also lead to symptoms resembling prolapse.
Ovarian Cysts: Cysts on the ovaries can cause pelvic pressure and discomfort.
Vaginitis: Inflammation of the vagina may result in discharge and pelvic discomfort.
Management of Uterine Prolapse
The approach to managing uterine prolapse is tailored to the prolapse severity, the patient’s symptoms, and their overall health profile. Management options span from non-surgical to surgical interventions.
Conservative Management:
Pelvic Floor Muscle Exercises: Regular performance of Kegel exercises, involving the contraction and relaxation of pelvic floor muscles, helps strengthen support and reduce symptoms.
Estrogen Therapy (for Postmenopausal Women): Estrogen replacement therapy can improve tissue health and elasticity in postmenopausal women, potentially preventing further weakening.
Vaginal Pessary: A removable device inserted into the vagina to provide uterine support and maintain its position. It is a non-surgical option for women who wish to avoid surgery or are not suitable surgical candidates. Pessaries require professional fitting and come in various types.
Lifestyle Adjustments:
Weight Management: Maintaining a healthy body weight reduces excessive pressure on the pelvic floor.
Dietary Modifications: A diet rich in fiber can aid in preventing constipation and subsequent straining.
Activity Modification: Limiting heavy lifting and prolonged standing can help manage symptoms.
Definitive Management (Surgical Interventions):
Surgical options are considered when conservative methods are ineffective or for more severe prolapse cases.
Vaginal Hysterectomy: Surgical removal of the uterus performed through the vagina. Frequently used for uterine prolapse, particularly in women who have completed childbearing.
Abdominal Hysterectomy: Removal of the uterus via an abdominal incision. May be chosen for severe prolapse or when other pelvic pathologies are present.
Colpocleisis (Vaginal Obliteration): A surgical procedure that narrows the vaginal canal to provide support and eliminate prolapse. Typically considered for women who are not sexually active.
Sacrospinous Ligament Fixation: A procedure where the uterus is surgically attached to the sacrospinous ligament in the pelvis, providing support.
Sacrohysteropexy: Utilizes a mesh to suspend and attach the uterus to the sacrum (lower back bone). Considered a more durable surgical solution compared to sacrospinous fixation.
Prevention of Uterine Prolapse
Preventive measures can help reduce the risk of developing uterine prolapse:
Maintain Healthy Weight: Managing weight to avoid obesity, which increases pelvic floor strain.
Regular Pelvic Floor Exercises: Consistent Kegel exercises to strengthen pelvic floor muscles.
High-Fiber Diet: Consuming a diet rich in fiber to prevent constipation and straining during bowel movements.
Avoid Straining: Minimize straining during bowel movements and avoid heavy lifting.
Smoking Cessation: Quitting smoking to promote tissue health and elasticity.
Proper Lifting Techniques: Using correct body mechanics when lifting heavy objects, engaging leg muscles rather than back.
Consideration of Delivery Methods: Discussing with healthcare providers the potential impact of multiple vaginal deliveries on pelvic floor strength.
Prolapse of the Cervix
Cervical prolapse is a form of pelvic organ prolapse where the cervix descends into the vaginal canal, often occurring in conjunction with uterine prolapse. It’s important to remember that isolated cervical prolapse without uterine involvement is not possible, as the cervix is part of the uterus.
Causes:
The causes are similar to those of uterine prolapse, including:
Childbirth-related trauma
Aging and tissue weakening
Heavy lifting
Chronic coughing
Symptoms:
Symptoms are generally similar to uterine prolapse and may include:
Sensation of a vaginal bulge
Vaginal bleeding or unusual discharge
Difficulties with urination or bowel movements
Diagnosis:
Diagnosis is primarily made through:
Pelvic examination
Treatment:
Management approaches are similar to those for uterine prolapse:
Pelvic floor exercises
Vaginal pessary
Surgical interventions
Prolapse of the Bladder (Cystocele)
Cystocele, also known as bladder prolapse, is characterized by the displacement of the urinary bladder, causing it to descend and protrude into the vaginal space. This occurs because of compromised support structures within the pelvic region. When both cystocele and urethrocele (prolapse of the urethra) are present simultaneously, the condition is termed Cystourethrocele.
Factors Contributing to Cystocele:
Several factors can weaken the pelvic support and lead to the development of cystocele:
Persistent Constipation: Chronic straining during bowel movements can exert excessive pressure on the pelvic floor.
Heavy Physical Exertion: Repeatedly lifting heavy objects can strain and weaken pelvic muscles and ligaments.
Menopause and Estrogen Reduction: The hormonal changes associated with menopause, particularly the decline in estrogen, can lead to tissue thinning and reduced elasticity in the pelvic area.
Pregnancy and Parturition: The physical stresses of pregnancy and especially vaginal childbirth can significantly weaken pelvic floor supports.
Age-Related Changes: The natural aging process can result in the weakening of pelvic tissues and muscles over time.
Surgical Hysterectomy: Removal of the uterus can sometimes impact pelvic support structures, potentially contributing to prolapse.
Genetic Predisposition: Inherited factors may influence the strength and resilience of pelvic tissues.
Elevated Body Mass: Obesity places increased pressure on the pelvic floor, raising the risk of prolapse.
Iatrogenic Factors: Complications arising from operative vaginal deliveries or prior surgical repairs of the pelvic floor can sometimes contribute to cystocele development. Hysterectomy is also included in iatrogenic causes in some instances.
Pelvic Malignancies: Cancers within the pelvic region, such as cervical cancer, can sometimes contribute to pelvic organ prolapse.
Signs and Symptoms of Cystocele:
Individuals with cystocele may experience a range of symptoms, which can include:
Pelvic Fullness or Pressure Sensation: A persistent feeling of pressure, heaviness, or fullness within the pelvic area.
Urinary Control Problems: This can manifest as either involuntary urine leakage (incontinence) or difficulty passing urine (retention).
Recurrent Urinary Infections: Increased susceptibility to and frequency of urinary tract infections.
Incomplete Bladder Emptying: A sensation that the bladder is not fully emptied after urination.
Vaginal Protrusion: The presence of a bulge that can be felt or seen in the vagina.
Sense of Pelvic Descent: A feeling that something is dropping or protruding from the vagina.
Pelvic Heaviness: A general sensation of weight or heaviness in the pelvic region.
Urinary Stream Initiation Issues: Difficulty in starting the flow of urine.
Persistent Urge to Void: Frequent and/or urgent needs to urinate.
STAGES OF BLADDER PROLAPSE
The severity of bladder prolapse is classified into grades based on how far the bladder descends into the vagina:
Grade 1 (Mild): A small portion of the bladder descends into the vagina, representing a minor prolapse.
Grade 2 (Moderate): The bladder descends to a degree where it reaches the level of the vaginal opening.
Grade 3 (Severe): The bladder protrudes beyond the vaginal opening, becoming visible externally.
Grade 4 (Complete): The entire bladder is situated outside the vagina, indicating a complete prolapse.
Diagnosis of Cystocele
Diagnosis typically involves a combination of physical examination and potentially imaging or other tests to confirm the condition and rule out other issues.
Initial Assessment:
Pelvic Examination: A physical exam where the doctor visually and manually examines the vagina and cervix. This is done to identify any bulging or prolapse of the bladder into the vagina. The size and location of any prolapse are assessed to determine its grade.
Abdominal Examination: The doctor will also examine the abdomen to rule out any masses or abnormalities in the abdominal or pelvic area that could be contributing to the prolapse by exerting downward pressure on the pelvic organs.
Further Diagnostic Tests:
Urinalysis: A urine sample is tested to check for signs of urinary tract infection (UTI), as UTIs can sometimes cause similar symptoms or be a complication of cystocele.
Voiding Cystourethrogram (VCUG): This is a specialized X-ray study of the bladder and urethra. The bladder is filled with a contrast dye, and X-rays are taken while the patient urinates. VCUG helps to visualize the shape and function of the bladder and urethra, and can identify prolapse, narrowing (strictures), or leaks.
Cystoscopy: A minimally invasive procedure where a cystoscope—a thin, flexible tube equipped with a camera—is inserted through the urethra into the bladder. This allows direct visualization of the inner lining of the bladder and urethra, enabling the detection of any structural abnormalities, inflammation, or blockages.
Imaging Tests: These may be used to further evaluate the prolapse and to assist in treatment planning.
CT Scan of the Pelvis: Provides cross-sectional images of the pelvic organs and surrounding tissues, offering a detailed view to assess the extent of the cystocele.
Ultrasound of the Pelvis: A non-invasive imaging method using sound waves to create images of the pelvic organs. Useful for assessing prolapse and identifying potential contributing factors.
MRI Scan of the Pelvis: Magnetic Resonance Imaging gives highly detailed images of soft tissues, including pelvic floor muscles and ligaments, providing a comprehensive evaluation.
Evaluating Associated Conditions:
Stress Incontinence Test: To evaluate for stress urinary incontinence that may be associated with cystocele, a stress test may be performed. Typically, the patient is asked to cough or strain while the bladder is full to see if urine leakage occurs due to increased abdominal pressure.
Treatment of a Cystocele
Treatment strategies for cystocele are determined by the grade of prolapse and the severity of symptoms.
Mild Cases (Grade 1):
Often, mild cases do not require active medical or surgical intervention. Lifestyle modifications can be effective in managing symptoms:
Weight Management: Losing weight if overweight or obese can significantly reduce pressure on the pelvic floor.
Activity Modification: Avoiding or limiting heavy lifting and other activities that strain the pelvic floor.
Constipation Management: Maintaining regular bowel movements to prevent straining during defecation. This can be achieved through diet and hydration.
More Severe Cases (Grades 2-4):
For more pronounced prolapse or when symptoms significantly impact quality of life, treatment options include:
Pelvic Floor Exercises (Kegel Exercises): Regularly performing Kegel exercises to strengthen the pelvic floor muscles, which can improve support for the bladder and other pelvic organs.
Hormone Therapy (Estrogen Replacement Therapy): In some postmenopausal women, estrogen therapy can help improve the elasticity and strength of vaginal tissues, providing better support.
Vaginal Pessaries: These are removable devices inserted into the vagina to mechanically support the prolapsed bladder and other pelvic organs. Pessaries are a non-surgical option and are available in various shapes and sizes, requiring fitting by a healthcare provider.
Surgery: Surgical intervention is considered for significant prolapses or when conservative treatments are not effective. Surgical options aim to repair and strengthen the pelvic floor muscles and ligaments to restore the bladder to its normal position. In rare cases, a procedure called Colpocleisis, which narrows the vaginal opening, may be considered, particularly for women who are not sexually active and for whom other surgical options are not suitable.
Preventing a Cystocele
Several lifestyle and preventative measures can help reduce the risk of developing cystocele:
Consistent Pelvic Floor Exercises: Regularly performing pelvic floor exercises, such as Kegels, to maintain and improve the strength of these supportive muscles.
Limit Heavy Lifting: Reducing strain on the pelvic floor by avoiding or minimizing activities that involve heavy lifting. When lifting is necessary, using proper lifting techniques.
Maintain a Healthy Weight: Managing body weight to reduce excess pressure on the pelvic floor.
Promote Regular Bowel Movements: Preventing constipation by maintaining a high-fiber diet and adequate hydration to avoid straining during bowel movements.
Engage in Moderate Exercise: Regular physical activity can contribute to overall health and help maintain strength in pelvic floor muscles.
Rectal Prolapse
Rectal prolapse occurs when the rectum (the last section of the large intestine) falls from its normal position within the pelvic area
and protrudes through the anus.
It can involve a mucosal or full-thickness layer of rectal tissue
Epidemiology
Rectal prolapse is more frequently observed in older individuals, particularly those with a history of persistent constipation or weakened pelvic floor musculature. While it is more common among women, especially postmenopausal women over the age of 50, it can also affect younger people and even infants.
Types of Rectal Prolapse
Rectal prolapse is classified into several types based on the extent and nature of the protrusion:
External (Full-thickness) Prolapse: In this type, the entire wall thickness of the rectum protrudes outwards through the anal opening and is visible externally.
Mucosal Prolapse: This involves only the inner lining of the rectum, the mucous membrane, protruding through the anus. It’s a less severe form where just the mucosal layer descends.
Internal Prolapse (Intussusception): This occurs when a segment of the rectum folds in on itself and descends downwards, but it does not protrude outside the anus.
Internal Intussusception: A subtype where the rectal wall folds or telescopes inward, but remains within the anal canal and does not extend beyond the anus. This can involve the full thickness or a partial layer of the rectal wall.
Etiology and Risk Factors
Several factors can contribute to the development of rectal prolapse, often involving increased pressure in the abdomen and weakening of pelvic supports:
Chronic Straining During Defecation and Constipation: Persistent straining to pass stools weakens pelvic floor muscles and supporting tissues.
Pregnancy and Childbirth: The physical stress of pregnancy and vaginal delivery can weaken the pelvic floor.
Prior Surgical Interventions: Previous surgeries in the pelvic region can sometimes compromise pelvic support.
Chronic Respiratory Conditions (e.g., COPD): Conditions causing chronic coughing increase abdominal pressure.
Cystic Fibrosis: This genetic condition can lead to chronic cough and altered bowel habits, increasing risk.
Pertussis (Whooping Cough): Severe coughing associated with pertussis can strain the pelvic floor.
Chronic Diarrhea: Frequent bowel movements can contribute to weakening of rectal supports.
Pelvic Floor Dysfunction: Weakness or impaired function of the pelvic floor muscles.
Advanced Age: Natural aging processes can weaken tissues and muscles, including those supporting the rectum.
Neurological Conditions: Conditions affecting the nervous system, like spinal cord injuries, can impair muscle control in the pelvic floor.
Congenital Bowel Abnormalities (e.g., Hirschsprung’s disease): Birth defects affecting the bowel can predispose to prolapse.
Previous Anal or Pelvic Muscle Injury: Trauma to these areas can weaken support structures.
Nerve Damage: Damage to the nerves that control rectal and anal muscles can impair their function.
Pathophysiology
Mucosal prolapse arises when the connective tissues that anchor the rectal mucosa to the underlying muscle layers become weakened and stretched. This weakening allows the rectal mucosa to become detached and prolapse or slide downwards through the anus.
Clinical Features
The presentation of rectal prolapse can vary, but common symptoms include:
Mass Protruding from the Anus: A noticeable bulge or lump that appears outside the anus.
Variable Pain Levels: Pain associated with prolapse can range from mild discomfort to more significant pain.
Co-existing Pelvic Organ Prolapse: There is a potential association with other pelvic organ prolapses, such as uterine or bladder prolapse, occurring in a notable proportion of cases (10-25%).
Constipation Issues: Difficulty with bowel movements or constipation is reported in a significant percentage of patients (15-65%).
Rectal Bleeding: Bleeding from the rectum may occur due to irritation or trauma to the prolapsed tissue.
Fecal Incontinence: Involuntary leakage of stool can be a significant symptom, occurring in a wide range of cases (28-88%).
Defecation Difficulties and Incomplete Evacuation Sensation: Feeling of incomplete emptying of the bowels after defecation and difficulty in passing stools.
Diagnosis
Diagnosis of rectal prolapse typically involves:
History and Physical Examination: A medical history review and physical exam, including visual inspection, often reveals a protruding rectal mucosa and a characteristic thick, concentric ring of mucosal tissue.
Barium Enema and Colonoscopy: These imaging and endoscopic procedures allow visualization of the rectum and colon to assess for structural abnormalities or other pathology.
Proctography (Video Defecography): A dynamic X-ray study performed during defecation to document and assess internal prolapse and pelvic floor function.
Anal Electromyography (EMG): This test measures the electrical activity of the anal sphincter muscles to detect nerve damage or muscle dysfunction.
Anal Ultrasound: Utilizes sound waves to create images of the anal sphincter muscles, helping to evaluate their structure and integrity.
Pudendal Nerve Terminal Motor Latency Test: This test assesses the function of the pudendal nerves, which are important for bowel and bladder control.
Proctosigmoidoscopy: An endoscopic procedure to visualize the lower part of the colon (sigmoid colon and rectum) to rule out other conditions.
Magnetic Resonance Imaging (MRI): May be used to provide detailed imaging of the pelvic organs and surrounding structures for a comprehensive evaluation.
Management and Treatment
Management of rectal prolapse can range from non-operative to surgical approaches:
Surgical Treatment:
Perineal Rectosigmoidectomy: A surgical procedure performed through the perineum to remove the prolapsed section of the rectum.
Laparoscopic Approach: Minimally invasive surgical techniques using laparoscopy can be employed to repair rectal prolapse, often involving fixation of the rectum.
Nonoperative Management:
Manual Reduction: Gentle pressure applied with a finger can sometimes be used to push the prolapsed rectum back into place.
Edema Reduction Techniques: Applying substances like salt or sugar to the prolapsed tissue can help reduce swelling and facilitate manual reduction.
Non-surgical Management:
Conservative Bowel Management: For internal prolapse, non-surgical management may include bulking agents to add fiber to the diet, stool softeners to ease bowel movements, and suppositories or enemas to aid in evacuation.
Complications
Potential complications associated with rectal prolapse and its treatment include:
Infection: Risk of infection following surgical procedures.
Bleeding: Bleeding may occur during or after surgery or due to tissue damage.
Intestinal Injury: Accidental injury to the intestines during surgical repair.
Anastomotic Leakage: Leakage from the surgical connection (anastomosis) if bowel resection is performed.
Bladder and Sexual Function Alterations: Potential impact on bladder function and sexual function following surgery.
Constipation or Outlet Obstruction: Post-operative constipation or difficulty with bowel evacuation.
Fecal Incontinence: In some cases, fecal incontinence may persist or worsen after surgery.
Urinary Retention: Difficulty emptying the bladder after surgery.
Medical Complications from Surgery: General surgical risks such as heart attack, pneumonia, or deep vein thrombosis.
Prevention
Preventive strategies to reduce the risk of rectal prolapse include:
Increase Dietary Fiber Intake: Consume a diet rich in fiber, aiming for at least five servings of fruits and vegetables daily to promote regular bowel movements.
Adequate Hydration: Drink 6 to 8 glasses of water daily to maintain stool consistency and ease bowel movements.
Regular Physical Exercise: Engage in regular physical activity to maintain overall health and bowel function.
Maintain a Healthy Weight: Achieve and maintain a healthy body weight to reduce pressure on the pelvic floor.
Use Stool Softeners or Laxatives: If frequent constipation is an issue, consider using stool softeners or mild laxatives under medical guidance.