Rectal Prolapse

Question 1

Define

Answer 1

The mucosa (partial/type 1) or all layers (complete/type 2) protrude through the anus

Complete is more common

Question 2

Causes

Answer 2

due to a lax sphincter or prolonged straining Related to chronic neurological and psychological disorders

Prolapses can occur either with bowel movements or independently

Question 3

Risk factors

Answer 3

• ↑intra-abdominal pressures (e.g. constipation, diarrhoea, BPH, pregnancy chronic cough)
•  Previous surgery
•  Pelvic floor dysfunction
•  Parasitic infections (schistosomiasis)
•  Neurological disease (previous lower back/pelvic trauma, lumbar disc disease, cauda-equina syndrome, spinal tumours, MS)
•  Psychiatric disease

In children →rectal prolapse may be associated CF, Ehlers-Danlos syndrome, Hirschsprung’s disease, congenital megacolon, malnutrition and rectal polyps

Question 4

Epidemiology

Answer 4

Uncommon but may be due to underreporting of cases More common in elderly but can affect all ages

Complete prolapse in adults is more common in women

Question 5

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

Answer 6

When visualised on examination: protruding mass shows concentric rings of mucosa
Examination may also reveal a rectal ulcer and ↓anal sphincter tone

Question 7

Investigations

Answer 7

Imaging

• Proctosigmoidoscopy
• Defecating proctogram or barium enema

Other

• Anal sphincter manometry
• Pudendal nerve studies

Sweat Chloride Test

• Performed in children to test for cystic fibrosis