Rectal Prolapse

Question 1

What is Type 1 Rectal Prolapse?

Answer 1

Only the rectal mucosa protrudes through the anus

Question 2

What is Type 2 Rectal Prolapse?

Answer 2

All layers of the rectum protrude through the anus, creating a mass which has palpable, concentric muscular rings

Question 3

Give 2 broad causes of Rectal Prolapse

Answer 3

Straining 
Abnormal rectal anatomy or physiology (e.g. pelvic floor weakness, poor fixation of rectum to sacrum or reduced anal sphincter pressure) 

Question 4

List 5 risk factors for Rectal Prolapse

Answer 4

Constipation  
Causes of increased straining  
Cystic fibrosis (in children) 
Previous trauma to the anus/ perineum 
Neurological conditions (e.g. cauda equina syndrome, MS)

Question 5

Describe the epidemiology of Rectal Prolapse

Answer 5

Relatively COMMON

Most commonly affected: CHILDREN (< 3 yrs) + ELDERLY 

Question 6

List 6 presenting features of Rectal Prolapse

Answer 6

Protruding anal mass  
Initially associated with defecation  
May require digital replacement  
Constipation  
Faecal incontinence (in 75%) 
PR mucus or bleeding 

Question 7

List 3 signs of Rectal Prolapse

Answer 7

Prolapse may be seen on straining 
Ulcerated or necrotic if vascular supply is compromised 
Reduced anal sphincter tone 

Question 8

What investigations may be performed for Rectal Prolapse?

Answer 8

Proctosigmoidoscopy 

Defecating proctogram/ Barium enema 

Question 9

What test may be performed in children with Rectal Prolapse? Why?

Answer 9

Sweat Chloride Test

To test for cystic fibrosis 

Question 10

What is Rectal Prolapse?

Answer 10

Abnormal protrusion of the full thickness (or only mucosal layer) of rectum through the anus

Question 11

When is rectal prolapse an emergency?

Answer 11

Irreducible or strangulated prolapse