Anatomical problems of the lower part of the digestive system On the lower part of the digestive system

Table of Contents

What is the lower part of the digestive system?

The lower part of the digestive system is the last section of the digestive system, and it is made up of the large intestine and the anus.

The large intestine absorbs water and transforms waste from the digestive process from liquid to stool. The large intestine includes:

  • the appendix, a finger-shaped pouch attached to the caecum
  • the caecum, the first part of the large intestine, which is connected to the end of the small intestine
  • the colon, which has four sections: the ascending colon, the transverse colon, the descending colon, and the sigmoid colon
  • the rectum, the lower end of the large intestine that leads to the anus

The anus is a 1-inch opening at the tip of the digestive system through which stool leaves the body. The anus includes the sphincter muscles, which are the muscles that open and close and allow you to control bowel movements.Lower part of the digestive system

What are anatomical problems of the lower part of the digestive system?

Anatomical problems of the lower part of the digestive system are problems related to its structure. The lower parts of the digestive system may be in the wrong place, have an abnormal shape, or be abnormally connected to other parts of the body.

Some anatomical problems of the lower part of the digestive system arise when this part does not develop normally before birth. These are known as birth defects and include:

Other anatomical problems, which could be present at birth or develop later, include:

Anorectal malformations (imperforate anus)

What are anorectal malformations?

Anorectal malformations are birth defects of a child’s anus or rectum that interfere with the normal passage of stool. When the anus is completely blocked, the condition is known as an imperforate anus.

In children with anorectal malformations, the anus may be missing, blocked by a thin or thick layer of tissue, or narrower than normal. In rare cases, the anus may be normal but the rectum is blocked or narrowed.

Many children with anorectal malformations have a fistula, or abnormal passage, between the rectum and another part of the body such as:

  • the perineum, the skin between the anus and genitals
  • the urethra or bladder
  • the vagina

In some children with anorectal malformations, the rectum and urinary tract share the same opening. This abnormality is known as a cloaca.

How common are anorectal malformations?

About 1 in 5,000 babies is born with anorectal malformations. 1

Who is most likely to be born with anorectal malformations?

Boys are slightly more likely than girls to be born with anorectal malformations. 1

If parents have a child with an anorectal malformation, the chance that another child will be born with the condition is 1 in 100, which is higher than the average risk of 1 in 5,000. 1

What other health problems do children with anorectal malformations have?

Children with anorectal malformations can have birth defects that affect other parts of the body. These could include defects of:

  • the urinary tract and genitalia
  • the heart
  • spinal column
  • the digestive tract
  • trachea
  • the kidneys
  • The arms and the legs

In some cases, children with Down syndrome also have anorectal malformations. 

What are the complications of anorectal malformations?

If anorectal malformations are not diagnosed and treated soon after birth, the baby may develop symptoms of intestinal obstruction such as vomiting, bloating, and problems with bowel movements. Bowel obstruction can cause serious complications, such as a hole in the wall of the intestine (perforation), severe infection, and sepsis .

After anorectal malformations have been treated with surgery, some people may have complications later in life such as:

What are the signs of anorectal malformations?

When examining a newborn baby, doctors can find signs of anorectal malformations such as:

  • sin ano visible
  • an anal opening that is not in the normal location
  • a tighter or narrower anus than normal

In the first 24 hours after birth, babies with anorectal malformations may not pass stool or pass it through a fistula through the perineum, urethra, or vagina.

Babies with signs of anorectal malformation need immediate medical treatment to prevent complications.

What Causes Anorectal Malformations?

Anorectal malformations occur when the anus and rectum do not develop normally before birth. Experts don’t know what causes problems with the development of the anus and rectum. However, genes or changes in genes, known as mutations , may play a role.

How do doctors diagnose anorectal malformations?

Doctors diagnose anorectal malformations with a physical exam and imaging tests. They may also order tests to check for other health problems that are common in children with anorectal malformations.

Physical exam

Shortly after the baby is born, the doctor will examine the baby from head to toe. Doctors often diagnose anorectal malformations during this exam. They will also examine the baby’s perineum and genitals and check for other birth defects.Doctors often diagnose anorectal malformations during the physical exam.

Imaging tests

Doctors may use the following tests to examine defects of the anus and rectum:

  • ultrasound , which uses sound waves to create a picture of organs
  • X-rays , which use a small amount of radiation to create pictures of the inside of the body
  • magnetic resonance imaging (MRI) , which takes pictures of the body’s internal organs and soft tissues without using X-rays

How do doctors treat anorectal malformations?

Doctors treat anorectal malformations with surgery. The type of surgery depends on the location and type of malformation.

Doctors often do the surgery in the first few days after the baby is born. In some cases, they can repair the anorectal malformation with a single operation; in others, they first do a colostomy to attach the colon to a stoma, an opening in the abdomen that allows stool to pass out of the body, and later repair the anorectal malformation with one or more operations as the baby grows .

Doctors may recommend regular follow-up and additional treatments for any complications that develop after surgery or later in life.

Bibliography

[1] Wood RJ, Levitt MA. Anorectal malformations. Clinics in Colon Rectal Surgery. 2018;31:61–70.

Colonic atresia and stenosis

What are colonic atresia and stenosis?

Colonic atresia is a birth defect (congenital) in which a part of the colon is missing or blocked. Colonic stenosis, which could be a birth defect or develop later in life, is a disorder in which part of the colon is narrower than normal.

How common are colonic atresia and stenosis?

About 1 in 10,000 to 66,000 babies is born with colonic atresia. two

Experts don’t know how common it is. At birth, colonic stenosis is rarer than colonic atresia. 3 Most cases of colonic stenosis develop later in life and are caused by injury or inflammation .

Who is more likely to develop colonic atresia and stenosis?

Experts don’t know who is more likely to have colonic atresia and stenosis at birth.

People are more likely to develop colonic stenosis later in life if they have an injury or inflammation of the colon that could cause stricture.

Premature babies can develop colonic stenosis after having necrotizing enterocolitis , a disorder in which the wall of the intestine is severely damaged.

What other health problems do babies born with colonic atresia have?

Babies born with colonic atresia can have other birth defects, including:

What are the complications of colonic atresia and stenosis?

Colonic atresia causes intestinal obstruction, meaning that the colon is completely blocked. If colonic atresia is not diagnosed or treated soon after the baby is born, bowel obstruction can cause serious complications such as:

  • dehydration
  • perforation or hole in the wall of the intestine
  • infection and septicemia , a serious illness that occurs when the body has an overwhelming immune system response to an infection.

Colonic stenosis can also cause intestinal obstruction and its complications.

What are the signs and symptoms of colonic atresia and stenosis?

Colonic atresia and stenosis may cause signs and symptoms due to intestinal obstruction. Anyone with signs or symptoms of intestinal obstruction needs immediate medical attention.

Signs of intestinal obstruction due to colonic atresia include:

  • abdominal distention or visible swelling of the abdomen
  • inability to have a bowel movement
  • vomiting, often bilious, making it green in color

These signs usually appear in babies shortly after birth.

Colonic stenosis can also cause intestinal obstruction, and the signs and symptoms may be similar to those of colonic atresia. Signs and symptoms may be milder or come and go if the colon is not completely blocked.

What Causes Colonic Atresia and Stenosis?

Experts are not sure what causes colonic atresia and stenosis as birth defects. One theory is that before birth, something happens that reduces blood flow to part of the colon.

An injury or inflammation of the colon can cause colonic stenosis at any time during a person’s life. For example, necrotizing enterocolitis is a common cause of colonic stenosis in infants. Later in life, an inflammatory bowel disease, such as Crohn’s disease , is a cause of colonic stenosis or constriction.

How do doctors diagnose colonic atresia and stenosis?

To diagnose colonic atresia and stenosis, doctors ask about symptoms and medical history, and do a physical exam and imaging tests.

Physical exam

During the physical exam, the doctor may:

  • check for bloating
  • check for a lump or mass in the abdomen
  • palpate the abdomen to see if it is tender or painful
  • use a stethoscope to listen to sounds in the abdomen
  • check for signs of complications , such as dehydration or infection

During a physical exam, the doctor may check for abdominal distention or a mass in the abdomen.

Imaging tests

Doctors may use the following tests to diagnose colonic atresia and stenosis:

  • X-rays , which use a small amount of radiation to create pictures of the inside of the body
  • ultrasound , which uses sound waves to create a picture of organs
  • lower digestive tract transit , which uses X-rays and a chalky fluid (barium) to check the large intestine

How do doctors treat colonic atresia and stenosis?

Doctors treat colonic atresia and stenosis with surgery to remove the blocked or narrow part of the colon and join the healthy ends of the colon together.

In some cases, doctors treat colonic atresia or stenosis with surgery; In others, they first do a colostomy to attach the colon to a stoma, an opening in the abdomen that allows stool to escape from the body, and later do a second surgery to attach the healthy ends of the colon to each other.

Bibliography

[2] Adams SD, Stanton MP. Malrotation and intestinal atresias. Early Human Development. 2014;90(12):921–925.

[3] Mirza B, Iqbal S, Ijaz L. Colonic atresia and stenosis: our experience. Journal of Neonatal Surgery. 2012;1(1):4.

Malrotatión intestinal

What is intestinal malrotation?

Intestinal malrotation is a birth defect that occurs when the intestines do not rotate correctly or completely to their normal final position during development. People born with intestinal malrotation may develop symptoms and complications, most often as infants, but sometimes later in life. Some people with intestinal malrotation never develop symptoms or complications .

How common is intestinal malrotation?

Experts aren’t sure how common intestinal malrotation is because not everyone with this condition has signs or symptoms. Some studies suggest that about 1 in 500 people have intestinal malrotation. 4

Who is more likely to have intestinal malrotation?

Intestinal malrotation is most often diagnosed in babies. Up to 80 percent of babies with intestinal malrotation are diagnosed in the first month after birth. 5.6Most babies with intestinal malrotation are diagnosed in the first month of birth

What other health problems do people with intestinal malrotation have?

Children with intestinal malrotation may have other birth defects, including defects of:

  • the digestive tract
  • abdominal wall
  • the heart
  • bile ducts
  • the pancreas

What are the complications of intestinal malrotation?

Intestinal malrotation can cause volvulus or torsion of the small intestine. Intestinal malrotation can also cause intestinal obstruction because the fold of the mesentery, the tissues that hold the intestines in place, presses against the duodenum. These problems can cause serious and life-threatening complications such as:

  • lack of blood flow to the blocked part of the intestine and death of blood-deprived tissues
  • perforation or hole in the wall of the intestine
  • peritonitis, an inflammation of the lining of the abdominal cavity
  • septicemia , a serious disease that occurs when the body has an overwhelming immune system response to an infection
  • shock

What are the symptoms of intestinal malrotation?

If a person has signs or symptoms of intestinal malrotation they should seek medical attention immediately.

Common signs of intestinal malrotation in babies younger than 1 year include: 7

  • vomiting, often bilious, making it green in color
  • developmental delay
  • pain or tenderness in the abdomen
  • abdominal distension
  • bleeding from the rectum or bloody stools

In children older than 1 year and adults, common signs and symptoms include: 7

  • pain in abdomen
  • threw up
  • sickness
  • diarrhea
  • abdominal distension
  • constipation
  • bleeding from the rectum or bloody stools
  • developmental delay in children

If intestinal malrotation and its complications cut off blood flow to the intestines and cause shock, symptoms could include:

  • confusion or loss of consciousness
  • fast heartbeat
  • pale skin
  • sweating

What Causes Intestinal Malrotation?

Experts do not know the cause of intestinal malrotation. However, genes or changes in genes, known as mutations , may play a role.

How do doctors diagnose intestinal malrotation?

Doctors diagnose intestinal malrotation based on medical and family history, a physical exam, and imaging tests.

Physical exam

During the physical exam, the doctor will check for signs of pain, tenderness, or visible abdominal distention or swelling, and may use a stethoscope to listen for sounds inside the abdomen. He may also check for signs of shock, such as a racing pulse or low blood pressure.

Imaging tests

Doctors may use the following imaging tests to diagnose intestinal malrotation:

  • X-rays , which use a small amount of radiation to create pictures of the inside of the body

How do doctors treat intestinal malrotation?

Doctors treat intestinal malrotation and its complications with surgery. During surgery, the surgeon may:

  • separating any tissue fold in the abdomen that is causing or could cause complications
  • changing the position of the intestines to decrease the risk of future complications
  • unscrew any volvulus
  • remove any part of the intestine damaged by a volvulus
  • remove the appendix, as intestinal malrotation can make it difficult to diagnose appendicitis if the patient develops this condition in the future

Bibliography

[4] Hall NJ. Chapter 3: Congenital problems of the gastrointestinal tract. In: Guandalini S, Dhawan A, Branski D, eds. Textbook of Pediatric Gastroenterology, Hepatology and Nutrition. Basel, Switzerland: Springer International Publishing; 2015;23–34.

[5] Shalaby MS, Kuti K, Walker G. Intestinal malrotation and volvulus in infants and children. BMJ. 2013;347:f6949.

[6] Haak BW, Bodewitz ST, Kuijper CF, de Widt-Levert LM. Intestinal malrotation and volvulus in adult life. International Journal of Surgery Case Reports. 2014;5:259–261.

[7] Nehra D, Goldstein AM. Intestinal malrotation: varied clinical presentation from infancy through adulthood. Surgery. 2011;149(3):386–393.

Intussusception

What is intussusception?

Intussusception is a disorder in which part of the intestine folds into itself, much like a folding telescope. Usually the last part of the small intestine, known as the ileum, folds into the first part of the large intestine, known as the cecum.

How common is intussusception?

In the United States, about 35 to 40 of every 100,000 babies under 1 year of age are hospitalized for intussusception. 8 Intussusception is the most common cause of intestinal obstruction in infants and young children. 9.10

Who is most likely to have intussusception?

Babies and young children are more likely than adults to have intussusception. Intussusception is most common in babies younger than 1 year old, and about 90 percent of cases occur in children younger than 3 years old. eleven

Intussusception is very rare in adults. Only about 5 percent of intussusception cases occur in adults. eleven

Intussusception is more common in boys than girls. eleven

What are the complications of intussusception?

Without treatment, intussusception can cause life-threatening complications such as:

  • intestinal obstruction
  • dehydration
  • lack of blood flow to the blocked part of the intestine and death of blood-deprived tissues
  • perforation or hole in the wall of the intestine
  • peritonitis, an infection of the lining of the abdominal cavity
  • septicemia , a serious disease that occurs when the body has an overwhelming immune system response to an infection
  • shock

What are the symptoms of intussusception?

Anyone with signs or symptoms of intussusception or its complications should seek immediate medical attention.

Signs and symptoms of intussusception in infants and children may include:

  • severe pain with cramps or cramps in the abdomen
  • crying without consolation
  • raise your knees to your chest
  • lethargy or lack of energy
  • threw up
  • stools mixed with blood and mucus (jelly-like reddish stools)

Symptoms of intussusception in adults could include:

  • pain in abdomen
  • sickness
  • threw up
  • bleeding from the rectum or bloody stools
  • constipation
  • abdominal distension

Signs and symptoms of complications from intussusception may include:

  • signs of dehydration, such as thirst, urinating less than normal, and tiredness
  • signs of infection, such as fever
  • signs of shock, such as confusion or loss of consciousness, fast heartbeat, pale skin, and sweating

What Causes Intussusception?

Children

In most cases of intussusception in infants and young children, doctors cannot find a cause. Research suggests that virus or bacterial infections can increase the likelihood of intussusception.

In children, doctors can find the cause of intussusception in only 2 to 12 percent of cases. 11 These causes include:

Adults

In adults, doctors can find the cause of intussusception in about 90 percent of cases. 12 Causes of intussusception in adults include:

How do doctors diagnose intussusception?

To diagnose intussusception, doctors ask about symptoms and medical history, and do a physical exam and imaging tests.

Physical exam

During the physical exam, the doctor may:

  • check for bloating
  • check for a lump or mass in the abdomen
  • palpate the abdomen to see if it is tender or painful
  • use a stethoscope to listen to sounds in the abdomen
  • check for signs of complications , such as dehydration or infection

During the physical exam, the doctor may use a stethoscope to listen for sounds in the abdomen.

Imaging tests

Doctors may use the following tests to diagnose intussusception

  • X-rays , which use a small amount of radiation to create pictures of the inside of the body
  • ultrasound , which uses sound waves to create a picture of organs
  • lower digestive tract transit , which uses X-rays and a chalky fluid (barium) to check the large intestine
  • computed tomography (CT) , which uses a combination of x-rays and computer technology to create images; it is most commonly used in adults.

How do doctors treat intussusception?

In infants and children, doctors usually treat intussusception by doing an enema procedure similar to a lower digestive tract transit. The doctor inserts a tube through the anus and, guided by radiographic images, fills the large intestine with air, barium, or another substance to push the folded intestine back to its normal position.

Your doctor may need to do surgery to treat intussusception if the enema procedure doesn’t work. You may also do surgery if the cause or complications of intussusception need treatment.

In adults, doctors usually treat intussusception with surgery.

Bibliography

[8] Tate JE, Yen C, Steiner CA, Cortese MM, Parashar UD. Intussusception rates before and after the introduction of rotavirus vaccine. Pediatrics. 2016;138(3):e20161082.

[9] Jiang J, Jiang B, Nguyen T, Bines J, Patel MM. Childhood intussusception: a literature review. Plos One. 2013;8(7):e68482.

[10] Edwards EA, Pigg N, Courtier J, Zapala MA, MacKenzie JD, Phelps AS. Intussusception: past, present and future. Pediatric Radiology. 2017;47:1101–1108.

[11] O’Sullivan L, Desai AP. Chapter 48: Intussusception. In: Guandalini S, Dhawan A, Branski D, eds. Textbook of Pediatric Gastroenterology, Hepatology and Nutrition. Basel, Switzerland: Springer International Publishing; 2015;561–566.

[12] Marsicovetere P, Ivatury SJ, White B, Holubar SD. Intestinal intussusception: etiology, diagnosis, and treatment. Clinics in Colon and Rectal Surgery. 2017;30(1):30–39.

Colonic and anorectal fistulas

What are colonic and anorectal fistulas?

A fistula is an abnormal passage, or tunnel, in the body. An internal fistula is an abnormal tunnel between two internal organs. An external fistula is an abnormal tunnel between an internal and external organ.

A colonic fistula is an abnormal tunnel from the colon to the surface of the skin or to an internal organ such as the bladder, small intestine, or vagina.

An anorectal fistula is an abnormal tunnel from the anus or rectum to the surface of the skin around the anus. Women can have rectovaginal fistulas, which are anorectal fistulas between the anus or rectum and the vagina.

How common are colonic and anorectal fistulas?

Colonic fistulas are very rare and could occur as a complication of surgery or a condition such as diverticulitis , Crohn’s disease, or cancer .

Studies conducted in Europe have found that about 1 to 2 in 10,000 people have anorectal fistulas. 13 Anyone can develop an anorectal fistula, which usually begins as an infection in a gland inside the anus. Anorectal fistulas are more likely to occur in people who have had an anorectal abscess or Crohn’s disease.

Anorectal fistulas are more common in men than women. While anorectal fistulas can occur in people of any age, the average age of people with anorectal fistulas is about 40 years. 13.14

What are the complications of colonic and anorectal fistulas?

Colonic fistula

Colonic fistulas can cause complications such as:

  • problems with fluid and electrolyte balance in the body, such as dehydration or low levels of certain electrolytes
  • malnutrition
  • infections, such as urinary tract infections
  • peritonitis, an inflammation of the lining of the abdominal cavity
  • abscesses, which are painful and inflamed pus-filled areas caused by infections
  • septicemia , a serious disease that occurs when the body has an overwhelming immune system response to an infection

Anorectal fistula

Anorectal fistulas cause infections and abscesses around the anus, but they rarely cause serious infection. In very rare cases, cancer may develop in an anorectal fistula.

What are the symptoms of colonic and anorectal fistulas?

A doctor should be consulted if any symptoms of a colonic or anorectal fistula appear.

Colonic fistula

Colonic fistula symptoms vary, depending on the location of the fistula. The contents of the colon can enter the fistula and pass to the other end, which could be in the skin or in an internal organ.

Colonic fistula symptoms may include fluid, stool, and gas passing:

  • through an opening in the skin
  • in urine
  • through the vagina

A fistula that connects the colon to another part of the intestines could cause symptoms such as:

In some cases, colonic fistulas do not cause symptoms.

Anorectal fistula

Symptoms of an anorectal fistula could include:

  • drainage of pus from an opening in the skin around the anus
  • swelling and pain near the anus that may come and go, sometimes with redness or fever
  • anal pain

In women, a rectovaginal fistula may cause symptoms such as passing stool or gas through the vagina.

What Causes Colonic and Anorectal Fistulas?

Most colonic and anorectal fistulas are acquired, that is, they are not present at birth and develop at some point in life.

Colonic fistula

The most common cause of colonic fistulas is abdominal surgery. Diseases that cause inflammation of the digestive tract, such as Crohn’s disease and diverticular disease , can also cause fistulae to form. Other causes include cancer, radiation therapy, and trauma or injury to the abdomen.The most common cause of colonic fistulas is abdominal surgery

Anorectal fistula

Anorectal abscesses, caused by infections of the anal glands, are the most common cause of anorectal fistulas.

Certain health problems can also cause anorectal fistulas, such as Crohn’s disease, cancer, and some infections such as tuberculosis and HIV . Injury to the anorectal area due to surgery, childbirth, injury, or radiation therapy can also cause anorectal fistulas.

How do doctors diagnose colonic and anorectal fistulas?

Doctors diagnose colonic and anorectal fistulas based on symptoms and medical history, physical exam, and imaging tests.

Clinic history

The doctor will ask about symptoms and a history of conditions that could cause fistulas, such as abdominal surgery, Crohn’s disease, diverticular disease, radiation therapy, or injury.

Physical exam

The doctor will examine the tenderness or pain in the abdomen and may use a stethoscope to listen to the sounds inside the abdomen. They will also examine any openings in the skin to determine if you might have an external colonic fistula.

To check for an anorectal fistula, the doctor will check the skin around the anus for abnormal openings, pain, and signs of inflammation or infection. He may also do a digital rectal exam and an anoscopy or proctoscopy to examine the inside of the anus and rectum.

Imaging tests

Doctors may use several different imaging tests to diagnose or examine colonic or anorectal fistulas. The type of test depends on the suspicious location of the fistula. The tests could include:

Doctors may order additional tests to detect complications or diagnose conditions that can cause fistulas, such as Crohn’s disease or cancer. If the fistula is connected to an internal organ, such as the bladder, small intestine, or vagina, doctors may order additional tests to examine these organs.

How do doctors treat colonic and anorectal fistulas?

Colonic fistula

Some colonic fistulas will close on their own without surgery. The doctor may only treat or prevent any complications to help the fistula heal. Depending on the needs of the patient, the doctor may:

  • give fluids and electrolytes
  • give you nutritional support , which could include total parenteral nutrition (intravenous nutrition) or enteral nutrition (the patient receives liquid food through a tube placed in the nose, stomach, or small intestine)
  • prescribe antibiotics and drain any abscesses to treat the infection
  • protect the skin from fluid leaking from the fistula if the fistula is external

If the fistula is not likely to close spontaneously, doctors do surgery to close it.

Anorectal fistula

Doctors usually treat anorectal fistulas with surgery. Most anorectal fistulas do not close without surgery; however, some rectovaginal fistulas can close on their own. If the patient has a rectovaginal fistula, the doctor may recommend delaying surgery to see if the fistula closes.

If you have an anorectal fistula with an abscess, your doctor will drain the abscess to treat the infection. In some cases, doctors may prescribe antibiotics to treat the infection.

Bibliography

[13] Simpson JA, Banerjea A, Scholefield JH. Management of anal fistula. BMJ. 2012;345:e6705.

[14] Sneider EB, Maykel JA. Anal abscess and fistula. Gastroenterology Clinics of North America.2013;42:773–784.

Rectal prolapse

What is rectal prolapse?

Rectal prolapse occurs when the mucosa of the rectum descends through the anus. In a complete rectal prolapse, the entire wall of the rectum descends through the anus. In a partial rectal prolapse, only the lining of the rectum descends through the anus.

How common is rectal prolapse?

Rectal prolapse is relatively rare. A study conducted in Finland found that, each year, about 2.5 out of 100,000 people are diagnosed with complete rectal prolapse. fifteen

Who is more likely to have rectal prolapse?

Among adults, rectal prolapse is more common in people over 50 and more common in women than men. About 80 to 90 percent of adults with rectal prolapse are women. 16

Rectal prolapse is very rare in children, and children with this condition are usually younger than 4 years old. 17Rectal prolapse is more common in women than men

What other health problems do people with rectal prolapse have?

Some women with rectal prolapse have weakened pelvic floor muscles. These women may have other problems related to weakened pelvic floor muscles such as:

  • hernia of the intestines (enterocele)
  • bulging of the rectum inside the front of the vagina (rectocele)
  • bulging or drooping of the bladder inside the vagina ( cystocele )
  • drooping of the uterus or vagina out of its normal positions (uterine or vaginal prolapse)

What are the complications of rectal prolapse?

Complications of rectal prolapse include:

  • ulcers in the rectum, which could cause bleeding
  • rectal prolapse that cannot be pushed back into the body, which is a medical emergency because it can cut off the blood supply to the part of the rectum that has descended through the anus
  • injury to the muscles and nerves of the sphincter, causing or worsening bowel control problems (fecal incontinence)

What are the symptoms of rectal prolapse?

Rectal prolapse symptoms include:

  • a reddish mass protruding from the anus
  • constipation , diarrhea, or both
  • feeling that the rectum has not emptied after a bowel movement
  • passage of blood and mucus from the rectum
  • fecal incontinence

Without treatment, symptoms such as constipation and bowel control problems can get worse. Over time, the rectum can descend through the anus more often and easily. The rectum may not re-enter the body spontaneously and may need to be put back into place.

If you have symptoms of rectal prolapse, you should consult your doctor about treatment . Treatment can help prevent symptoms from getting worse and prevent complications.

Seek immediate medical attention if you have symptoms of complications, such as heavy bleeding or a rectal prolapse that cannot be pushed into the body.

What Causes Rectal Prolapse?

Experts are not sure what causes rectal prolapse. Certain structural defects and risk factors can increase the likelihood of a rectal prolapse.

Structural defects

In adults with rectal prolapse, doctors have found certain defects in the pelvis or lower part of the digestive tract. These defects could increase the chance of rectal prolapse, or rectal prolapse could cause or worsen these defects. Structural defects often found in adults with rectal prolapse include:

  • a rectum that is not fixed in place and may move more than normal
  • weakened pelvic floor muscles
  • weakened anal sphincters

In children with rectal prolapse, doctors have found differences in the structure of the rectum. For example, the rectum may not have the usual curve and be in a straight and vertical position, which could increase the probability of prolapse.

Risk factor’s

Certain conditions that increase pressure within the abdomen or weaken the pelvic floor muscles may increase the chance of rectal prolapse. For example:

  • chronic constipation or muscle strains during bowel movements
  • chronic diarrhea
  • Cystic fibrosis (English)
  • diseases and disorders that affect the nerves or tissues of the pelvic floor muscles
  • intestinal infections with certain parasites
  • pelvic surgery
  • whooping cough

How do doctors diagnose rectal prolapse?

To diagnose rectal prolapse, doctors ask about your medical history and symptoms and do a physical exam. In some cases, they also order tests.

Physical exam

The doctor will examine the patient’s anus to check for a complete or partial rectal prolapse. If the doctor does not see a prolapse, he or she may ask the patient to push as if they were having a bowel movement to see the rectal prolapse. The doctor may also do a digital rectal exam.

Tests

Doctors may order tests to confirm the diagnosis of rectal prolapse or to check for other problems. These tests could include:

  • defecography, which uses X-rays or MRI scans to create a video showing how well the rectum can hold and empty stool and structural changes in the rectum and anus
  • colonoscopy , which uses a long, flexible, narrow tube with a tiny, lightweight camera on one end to examine inside the rectum and colon
  • lower digestive tract transit , which uses x-rays and a chalky fluid (barium) to examine the large intestine

Doctors may order additional tests, such as anorectal manometry, to check how well the nerves and muscles in the rectum and anus are working.

How do doctors treat rectal prolapse?

In adults, doctors usually treat rectal prolapse with surgery. Even after surgery, rectal prolapse can recur. Reducing or avoiding constipation can make it less likely that it will happen again.

In children, doctors often treat rectal prolapse by focusing on the underlying cause, such as constipation, straining during bowel movements, or diarrhea. If treating the cause doesn’t work, then they can do surgery to correct the prolapse.

Colonic valve

What is colonic volvulus?

A colonic volvulus occurs when the colon twists around the tissue that holds it in place, known as the mesentery. That twist causes intestinal obstruction.

The most common types of colonic volvulus are:

  • sigmoid volvulus, which is a turn of the sigmoid colon
  • cecal volvulus, which is a gyrus of the cecum and ascending colon

How common is colonic volvulus?

Colonic volvulus is rare in the United States, causing fewer than 5 out of 100 cases of intestinal obstruction. 18

Colonic volvulus is most common in Africa, the Middle East, India, Russia, Eastern Europe, and South America. In these regions, colonic volvulus causes 13 to 42 out of 100 cases of intestinal obstruction. Experts think this condition is more common because people in these regions are more likely to eat a diet rich in fiber, which is a risk factor for colonic volvulus. 19

Who is more likely to have colonic volvulus?

Colonic volvulus is most common in adults between 50 and 80 years of age. Sigmoid volvulus is more common in men, while caecal volvulus is more common in women. twenty

Sigmoid volvulus is more common in older adults than:

  • suffer from chronic constipation
  • suffer from mental health or nervous system disorders
  • have chronic diseases
  • live in geriatric or psychiatric facilities

What are the complications of colonic volvulus?

Colonic volvulus can cause life-threatening complications. Twisting of the colon can cause:

  • intestinal obstruction
  • dehydration
  • lack of blood flow to the blocked part of the colon and death of blood-deprived tissues
  • perforation or hole in the wall of the intestine
  • peritonitis, an infection of the lining of the abdominal cavity
  • septicemia , a serious disease that occurs when the body has an overwhelming immune system response to an infection
  • shock

What are the symptoms of colonic volvulus?

If a person has symptoms or complications related to a colonic volvulus, they should seek medical attention immediately.

Colonic volvulus symptoms may include:

  • abdominal distension
  • constipation
  • cramps and pain in the abdomen
  • nausea and vomiting

Symptoms of complications related to a colonic volvulus may include:

  • signs of infection, such as fever
  • signs of shock, such as confusion or loss of consciousness, fast heartbeat, pale skin, and sweating

What Causes Colonic Volvulus?

Certain structural differences and risk factors could increase the likelihood of a colonic volvulus.

Structural differences

Experts think that certain structural differences in the cecum and colon increase the likelihood of a volvulus. For example:

  • sigmoid colon could be longer than average
  • the tissue that holds the sigmoid colon in place may allow it to move more than normal
  • the cecum and ascending colon may not be fixed in place and move more than usual

Risk factor’s

The chance of a colonic volvulus may be higher in people who:

  • have chronic constipation
  • use laxatives frequently
  • eat a diet rich in fiber
  • have had abdominal surgery

Sigmoid volvulus is more common in older adults who have chronic medical conditions or disorders that involve the nervous system and mental health. Sigmoid volvulus is also more common among older adults who live in geriatric or psychiatric facilities and spend a lot of time in bed.

In children, diseases such as Hirschsprung’s disease or Chagas disease can cause severe inflammation of the colon, known as megacolon, which can cause volvulus.

The probability of developing a caecal volvulus is higher in people who have had a colonoscopy or laparoscopy and in pregnant women.

How do doctors diagnose colonic volvulus?

Your doctor will diagnose colonic volvulus based on your symptoms and medical history, a physical exam, and medical tests.

Clinic history

The doctor will ask the patient about their symptoms and any history of conditions that could be risk factors for a colonic volvulus.The doctor will ask about your symptoms and any risk factors for a colonic volvulus.

Physical exam

During the physical exam, the doctor may:

  • check for bloating
  • palpate the patient’s abdomen to see if it is tender or painful
  • use a stethoscope to listen to sounds in the abdomen
  • check for signs of complications such as infection or shock

Imaging tests

Doctors may use one or more imaging tests to check for colonic volvulus. These tests could include:

How do doctors treat colonic volvulus?

Doctors usually treat colonic volvulus with surgery.

Vólvulo sigmoide

If the patient has no signs of injury to the colon, the doctor may use a flexible sigmoidoscopy to examine the sigmoid colon and attempt to unscrew the volvulus. If the procedure is successful, the doctor may schedule surgery to remove the affected part of the colon. This surgery can prevent volvulus from recurring. Doctors usually do flexible sigmoidoscopy and surgery during the same hospital stay.

If the colon is damaged or the doctor cannot unscrew the volvulus during flexible sigmoidoscopy, the patient will require immediate surgery to remove the affected part of the colon.

Vólvulo cecal

Doctors treat caecal volvulus with surgery; very often, the affected part of the cecum and colon are removed. In some cases, they may do surgery to unscrew the volvulus and attach the cecum to the abdominal wall to hold it in place.

Bibliography

[18] Perrot L, Fohlen A, Alves A, Lubrano J. Management of the colonic volvulus in 2016. Journal of Visceral Surgery. 2016; 153: 183–192.

[19] Umanskiy K, Matthews JB. Chapter 6: Colon: anatomy and structural anomalies. In: Podolsky DK, Camilleri M, Fitz G, et al, eds. Yamada’s Textbook of Gastroenterology. 6th edition. West Sussex: John Wiley & Sons, Ltd: 2016:93–107.

[20] Vogel JD, Feingold DL, Steward DB, et al. Clinical practice guidelines for colonic volvulus and acute colonic pseudo-obstruction. Diseases of the Colon & Rectum. 2016;59:589–600.

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