Rectal prolapse Flashcards
What is rectal prolapse?
Rectal prolapse = intussusception of the rectum through the anal canal
• Can range from rectal mucosa only to full thickness of rectum and sigmoid colon
• 3 types
o Type 1 – Mucosa protrudes
o Type 2 – full thickness of rectum protrudes
o Internal prolapse/intussusception
What is the aetiology of rectal prolapse?
• May be caused by a lax sphincter, prolonged straining (50%), as well as neurological and psychological disorders (leading to weakness of the pelvic floor)
What are the risk factors of rectal prolapse?
Elderly
Increased IAP o Chronic constipation o Diarrhoea o BPH o Pregnancy o Coughing (CF, COPD, pertussis)
Tumours
Neurological disease
o Previous lower back/pelvic trauma, lumbar disc disease
Psychiatric disease
Previous surgery
In children
o Cystic fibrosis
o Ehlers Danlos syndrome
o Hirschprung’s disease (absence of distal colonic ganglia)
What is the epidemiology of rectal prolapse?
- More common in the elderly
- More common in females (80-90%)
- Uncommon but underreported
- In children, usually presents between ages 1-3
What are the symptoms of rectal prolapse?
Pain
Incontinence (75%)
o Dilated anus
o Secretions from rectal mucosa
Constipation
Sensation of ‘something coming down’ o Early Initially only after a bowel movement Usually retracts upon standing o Later More often, with straining and Valsalva manoeuvres (e.g. sneezing, coughing) o Final Prolapses with daily activities – e.g. walking
Mucus and blood PR
What are the signs of rectal prolapse?
Mass protruding through the anus
o Concentric muscular rings of mucosa – type 2
Rectal ulcer
Decreased anal sphincter tone
What investigations are done for rectal prolapse?
Rectal prolapse = a symptom
Proctoscopy
o Exclude internal haemorrhoids and anal tumours
Colonoscopy
o Exclude tumour
Complete pelvic floor examination
o Risk of associated bladder or uterine prolapse
Children
o Sweat chloride test
