Rectal Prolapse

Question 1

Define Rectal Prolapse?

Answer 1

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

Question 2

What is the aetiology of Rectal Prolapse?

Answer 2

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

Question 3

What are the risk factors for Rectal Prolapse?

Answer 3

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

Question 4

What is the epidemiology of Rectal Prolapse?

Answer 4

Relatively common

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

Question 5

What are the presenting symptoms of Rectal Prolapse?

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

What are the signs of Rectal Prolapse 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

What imaging do we do for Rectal Prolapse?

Answer 7

Proctosigmoidoscopy

Defecating proctogram or barium enema

Question 8

What are the other investigations you do for Rectal Prolapse?

Answer 8

Anal sphincter manometry

Pudendal nerve studies

Question 9

Why do we do a Sweat Chloride Test for Rectal Prolapse?

Answer 9

Performed in children to test for Cystic Fibrosis