Rectal prolapse

Question 1

Define Rectal prolapse

Answer 1

When the last section of your colon slips through your anus

Can be external-outside the anus
Mucosal-part of the lining is sticking out
Internal-slipped from original position but not out of anus

Question 2

Aetiology and risk factors of rectal prolapse

Answer 2

Prolapse can either follow bowel movements or not (pressure). In elderly it might occur on defecation and retract immediately
Usually is more present when standing up-QOL problem

Risk factors:
Increase abdominal pressure (constipation, diarrhoea, BPH, pregnancy, chronic cough (COPD)
Previous surgery
Pelvic floor issues
Parasitic infections
Neuro issues (cauda equina, tumours, etc)
In children-CF/EDS

Question 3

Epidiemology of Rectal prolapse

Answer 3

Uncommon but true incidence isn’t clear
usually occurs in elderly females
for children-between year 1-3

Question 4

Signs and Sx of Rectal prolapse

Answer 4

Usually describe mass through anus
Initially only during defecation
Then more often, especially straining or coughing (valsalva)
Finally during daily activities (walking)-pt might have to put it back manually

Pain
Faecal Incontinence
Constipation
Mucus/blood in stool

DRE-concentric rings seen from anus-move when cough-classical sign (to differential from hemmoroids
Lowered anal tone

Question 5

Investigations of Rectal Prolapse

Answer 5

Diagnosis is clinical mainly
Colonoscopy too investigate colon before surgical repair
FIT tests
Sigmoidoscopy to investigate any additional lesion