prolapse

Prolapse literally means "To fall out of place". In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is used for organs protruding through the vagina or the rectum, or for the misalignment of the valves of the heart. A spinal disc herniation is also sometimes called "disc prolapse". Relating to the uterus, prolapse condition makes the organ extend inferiorly into the vagina causing weakened muscles.

In Humans

Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole.

Rectal Prolapse

Rectal prolapse is a condition in which part of the wall or the entire wall of the rectum falls out of place. In some cases, the rectum may stick out of the body (protrusion).

There are three types of rectal prolapse.

• Partial prolapse - The lining of the rectum falls out of place when you strain to have a bowel movement. Sometimes this is confused with an internal hemorrhoid (which may itself prolapse).
• Complete prolapse - The entire wall of the rectum falls and usually sticks out of the body. This may occur during bowel movements. It may occur walking or standing. Rarely, the tissue may remain outside the body all the time.
• Partial and complete prolapses may be able to be pushed back inside the body. The prolapse is then said to be reduced (pushed back inside).
• Internal prolapse (intussusception) - Part of the wall of the colon (large intestine) may slide into or over another part, much like the moving parts of the telescope. The tissue does not hang out of the body. It occurs inside (internal).

There are multiple causes of rectal prolapse. A life long habit of straining to have bowel movements, stresses involved in childbirth, weakening of the anal sphincter muscle, and/or weakening of the tendons that support the rectum are frequent causes. Neurological problems, such as spinal cord transaction or a spinal cord disease, can also lead to prolapse. In rare cases there may be a genetic predisposition. In most cases, though, no single cause can be identified.

Symptoms of a rectal prolapse may be:

• Leakage of stool
• Bleeding, anal pain, itching, irritation
• Tissue that protrudes from the rectum

Other accompanying symptoms may be:

• A feeling of having full bowels and an urgent need to have a bowel movement
• Passage of many very small stools
• The feeling of not being able to empty the bowels completely

Treatment should be aimed at avoiding constipation and avoiding straining to have a bowel movement. A diet rich in fiber and drinking 6 to 8 glasses of decaffeinated fluids every day will assist in keeping stools soft. In some cases physical therapy with biofeedback can assist with avoiding straining. If anal sphincter muscles are weak, Kegels are recommended. Physical therapy can also help strengthen weakened ligaments and anal sphincter muscles.

Two types of surgery are used to treat a complete prolapse. A surgeon may operate through the belly to secure part of the large intestine or rectum to the inside the abdominal cavity (rectopexy). Sometimes the surgeon removes the affected part of the intestine.

Surgery also can be done through the area between the genitals and the anus (perineum) to remove the prolapsing tissue

Surgery is most often successful for people who still have some control over their bowel movements. If the anal sphincter is damaged, surgery may correct the prolapse but not be able to completely correct fecal incontinence (lack of control of bowel movements). In some cases, fecal incontinence improves after prolapse surgery and in some cases fecal incontinence worsens.

If the lining has fallen out of the anus and is around 7cm or less, it should eventually retract back inside naturally. This can take up to 96 hours (4 days).

Pelvic Organ Prolapse

This is when the female pelvic organs fall from their normal position, into or through the vagina. This is seen in older women, especially those who have delivered large babies vaginally. Smoking and obesity both increase risk. Minor prolapse can be treated with exercises to strengthen the pelvic floor; more serious prolapse, e.g. complete proccidentia, require surgical treatment which may involve complete hysterectomy. The rectum or urinary bladder may prolapse, if the posterior or anterior wall of the vagina are damaged.

Symptoms may include: a feeling of pressure in the pelvis, or seeing organs protrude from the vagina. The change in position of organs may cause urinary symptoms.

In birds

An egg-bound budgerigar hen with a prolapsed vagina and her mate

Oviduct prolapse is an often fatal condition in birds. When an egg is laid, the vagina everts through the cloaca to deliver the egg. Large eggs and avian obesity are contributors to this condition. Immediate veterinary assistance is paramount to the survival of a bird with prolapse. Even with immediate medical intervention the chances for survival are usually uncertain. Untreated birds will begin to tear at the injury site. Other flockmates will begin to cannibalise the prolapse area. This behaviour is commonly known as pickout.

In cattle

Uterine prolapse in cattle, particularly dairy cattle, generally occurs in the first 12 hours post-calving. Frequent causes are hypocalcemia combined with irritation of the birth canal, causing straining. Replacement of the organ, which can be from softball-sized to the entire uterus hanging down below the hocks, is done with the cow in sternal recumbency, an epidural injection, and hindlimbs 'frogged' rearwards to allow the pelvis to tip forward, easing replacement. Careful washing and cleaning prior to replacement is important as is ensuring that the horns are completely everted once inside the cow. Often a Buhner suture is placed in the vulva to prevent subsequent re-prolapse.

In pigs

Rectal prolapse is a condition routinely identified in pigs on farms and at slaughterhouses. If not reduced quickly, prolapses in pigs become necrotic and infected, plus the additional risk of cannibalization by other pen mates. If the latter happens it normally results in death of the animal by septicemia, shock or faecal peritonitis.

External links

• IMM's Illustrations