Rectal Prolapse

Question 1

What are the 2 types of rectal prolapse?

Answer 1

Partial
-protrusion of rectal mucosa only

Complete
-protrusion of entire rectum i.e. all layers of the bowel wall

Question 2

What are the risk factors for developing a rectal prolapse?

Answer 2

Increasing age i.e. esp females

Pelvic floor dysfunction

Increased abdominal pressure

• pregnancy
• chronic cough
• child birth

Previous surgery

Question 3

How might someone with rectal prolapse present?

Answer 3

Mass protruding from anus which only occurs after bowels are open and retracts when standing
(NOTE: prolapse can occur more frequently and become more permenant with increased severity)

Pain

Faecal incontinence or constipation

Mucous discharge

Rectal bleeding

Question 4

What might you expect to see on examination?

Answer 4

Concentric mucosal rings

Reduced anal sphincter tone

Rectal ulcer

Question 5

What investigations would you do if someone was suspected of having a rectal prolapse?

Answer 5

Barium enema

Anal manometry
-assess the prolapse by inserting probe into rectum

Colonoscopy

Stool MC+S

Question 6

How can rectal prolapses by managed conservatively?

Answer 6

Manual reduction

High fibre diet

Good fluid intake

Circumanal rubber ring (when other measures not worked and the patient is not suitable for surgery)

Question 7

How can rectal prolapses by managed surgically?

When would a patient be indicated for an acute surgical review?

Answer 7

Excision of prolapsed muscosa

Haemorrhoidectomy

Abdominal approach-> suture fixation rectoplexy

Perineal approach -> anal encirclement

Acute surgical review:
-when prolapse is irreducible, strangulated or gangrenous
I.e. might be indication for emergency rectosigmoidectomy