Rectal Prolapse

Question 1

Define Rectal Prolapse and its degrees

Answer 1

Rectum loses its normal attachments and telescopes out through the anus, turning it inside out

First degree: >5cm protruding
Second degree: 2-5cm protruding
Third degree: occult

Question 2

Aetiology of Rectal Prolapse

Answer 2

Partial/total slip of rectal through anal orifice. The rectal mucosa is pushed through the external anal sphincter

In children may be caused by increased intra-abdominal pressure, cystic fibrosis and diarrhoea (Trichuris Trichura/Whipworm)

Question 3

Risk factors for Rectal Prolapse

Answer 3

Age (elderly)
Childbirth and pregnancy 
Chronic constipation or diarrhoea
Straining 
Prolapse of other pelvic organs 
Abnormalities in collagen 
Obesity

Question 4

Symptoms of Rectal Prolapse

Answer 4

Mass protruding through the anus (after defection, sneezing) - often painless
Discomfort
Pain/pain on walking
Constipation 
Difficult evacuation
Faecal incontinence 
Discharge of mucous or blood 

Females: vaginal bulge (rectocele), dyspareunia, lower back pain, urinary dysfunction, vaginal prolapse)

Question 5

Signs of Rectal Prolapse on exam

Answer 5

Mass protruding through the anus

Question 6

Investigations for Rectal Prolapse

Answer 6

Clinical diagnosis on exam - prolapse evident