Rectal Prolapse

Question 1

Definition

Answer 1

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

Question 2

Aetiology

Answer 2

Often from straining

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

Question 3

Risk factors

Answer 3

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

Question 4

Epidemiology

Answer 4

• Relatively COMMON

* Most commonly affected: CHILDREN (< 3 yrs) and the ELDERLY

Question 5

Presenting symptoms

Answer 5

• Protruding anal mass
• Initially associated with defecation
• May require digital replacement
• Constipation
• Faecal incontinence
• PR mucus or bleeding
• May be an EMERGENCY - irreducible or strangulated prolapse

Question 6

Signs on physical examination

Answer 6

• Prolapse may be seen on straining
• May be ulcerated or necrotic if the vascular supply is compromised
• Reduced anal sphincter tone

Question 7

Investigations

Answer 7

• Imaging
o Proctosigmoidoscopy
o Defecating proctogram or barium enema

• Other
o Anal sphincter manometry
o Pudendal nerve studies

• Sweat Chloride Test
o Performed in children to test for cystic fibrosis