Rectal prolapse

Question 1

Define:

Answer 1

Abnormal protrusion of the full thickness (or just the mucousal layer) of the rectum through the anus

Question 2

Aetiology:

Answer 2

Straining

Abnormal rectum anatomy/physiology such as pelvic floor weakness, poor fixation of the rectum, reduced anal sphincter pressure

Question 3

Risk factors:

Answer 3

Constipation

Neurological disorders such as MS and Cauda Equina syndrome

Increased straining

Previous trauma to the rectum or perianal area

Cystic fibrosis in children

Question 4

Epidemiology:

Answer 4

Relatively common

Mostly in children under three and the elderly

Question 5

Symptoms:

Answer 5

Protruding anal mass

Initially associated with defecation

May require digital replacement

Constipation

Faecal incontinence - 75%

PR mucous or bleeding

EMERGENCY IF IRREDUCIBLE OR STRANGULATED

Question 6

Signs:

Answer 6

Prolapse on straining

Ulcerated and necrotic if lack of vascular supply

reduced anal sphincter tone