Rectal Prolapse

Question 1

What is a rectal prolapse

Answer 1

protrusion of mucosal or full-thickness layer of rectal tissue out of the anus

Question 2

Which gender does rectal prolapse affect

Answer 2

Older women

Question 3

What are the two types of rectal prolapse

Answer 3

Partial thickness - the rectal mucosa protrudes out of the anus

Full thickness – the rectal wall protrudes out the anus

Question 4

What is the difference between internal intussuception and rectal prolapse

Answer 4

Internal intussusception is the prolapse of the rectum into the distal rectum or anal canal but without its protrusion outside of the anus

Question 5

What is the pathophysiology of full thickness prolapse

Answer 5

form of sliding hernia, through a defect of the fascia of the pelvic region.

Secondary to chronic straining, chronic cough, multiple vaginal deliveries.

Question 6

What is the pathophysiology of partial thickness prolapse

Answer 6

associated with the loosening and stretching of the connective tissue that attaches the rectal mucosa to the remainder of the rectal wall. This often occurs in conjunction with long standing haemorrhoidal disease.

Question 7

What are the risk factors for rectal prolapse

Answer 7

increasing age, female gender, multiple deliveries, straining, anorexia, and previous traumatic vaginal delivery.

Question 8

What are the clinical features of rectal prolapse

Answer 8

Rectal mucus discharge

Faecal incontinence

PR bleeding

Visible ulceration

Full thickness start internally therefore will have tenesmus, rectal fullness, repeated defecation

Question 9

What examination is performed and what are the typical findings

Answer 9

DRE

Weakened anal sphincter

Question 10

What investigations may need to be carried out to diagnose a internal prolapse

Answer 10

defecating proctography and examination under anaesthesia

Question 11

What is the conservative management for rectal prolapse

Answer 11

Increase fibre intake

Increase fluid intake

Banding in clinic

Question 12

What are the two surgical approaches in fixing rectal prolapses

Answer 12

Perineal approach

Abdominal approach

Question 13

What are the two operations in the perineal approach

Answer 13

Two most common operations in this are the delormes and altemeiers

Question 14

What is involved in the delormes operation

Answer 14

the prolapsed lining of the rectal mucosa is removed and the underlying muscle reinforced with plicated sutures

Question 15

What is involved in the altemeiers operation

Answer 15

resection of the redundant prolapsed bowel to restore the original anatomy.

Question 16

What does the abdominal approach entail

Answer 16

Performed laparoscopically and the procedure will involve a rectopexy, whereby the rectum is mobilised and fixed onto the sacral prominence via sutures or mesh