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Abbi cura del tuo corpo

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Prolasso rettale

Table of Contents

Definizione

Il prolasso rettale comporta la protrusione anale esterna di uno o più strati della parete rettale.
Il prolasso parziale è limitato allo strato mucoso e può essere occulto o palese e si può associare alla malattia emorroidaria.
Il prolasso mucoso viene classificato come: 

  • I grado quando il ponzamento è visibile sotto l’anello anorettale;
  • II grado quando raggiunge la linea dentata;
  • III grado quando arriva al margine anale.

Nel prolasso rettale completo (a tutto spessore) si distinguono quattro gradi:

  • I grado è il prolasso fino al margine anale;
  • II  grado corrisponde al prolasso fuori dall’ano che si riduce
    spontaneamente;
  •  III grado corrisponde al prolasso fuori dall’ano che può essere ridotto manualmente;
  • IV grado corrisponde al prolasso non riducibile.




Cause

Il prolasso rettale è più comune nelle donne anziane ma può verificarsi a qualsiasi età. I fattori predisponenti comprendono preesistenti disturbi della motilità pelvica, defecazione dissinergica e intussuscezione. L’ intussuscezione è caratterizzata dal prolasso a tutto spessore della parete rettale che non protrude attraverso
l’ano. Prolasso rettale e intussuscezione possono coesistere con il rettocele. Quest’ultimo è un’anormale protusione sacciforme della parete del retto verso la vagina (prolasso della parete anteriore) o meno frequentemente verso il sacro (prolasso della parete posteriore) che spesso diventa visibile durante la defecazione.



Il rettocele è comune nelle donne adulte e/o pluripare (20%);
in genere è di piccole dimensioni < 2 cm e asintomatico e non richiede alcun trattamento. Si ritiene che il rettocele sia il risultato della debolezza del setto rettovaginale e/o del pavimento pelvico, ma la causa esatta non è nota. Il 60% dei pazienti con rettocele ha una defecazione dissinergica. La visualizzazione del prolasso può essere possibile solo dopo il ponzamento.

Trattamento

Il trattamento non chirurgico (aumento dell’assunzione di fibre dietetiche e acqua, biofeedback), è spesso sufficiente per il prolasso mucoso di I e II grado. Procedure  transanali, come la legatura elastica, l’escissione mucosa, possono essere effettuate nei pazienti con prolasso mucoso di I  di II e III grado. Diverse procedure chirurgiche sono state proposte per il trattamento del prolasso rettale a tutto spessore  (laparotomia, laparoscopia, resezione rettale transanale con stappler, resezione rettale mediante robot) ma la loro efficacia deve essere ancora definita.

 

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