Rectal prolapse occurs when anorectal tissue slides through the anal orifice. Prolapse may be partial, involving only the mucosa (prolapse is <2 cm), or complete, involving in full thickness extrusion of the rectal wall. Prolapse may result from laxity of the pelvic floor, weak anal sphincters, and/or lack of mesorectal fixation. Patients complain of bleeding, mucous discharge, rectal pressure, or a mass. Problems with fecal incontinence, constipation, and rectal ulceration are common as well. Prolapse may be associated with an increased familial incidence, chronic cough, dysentery, or parasitic infection. Other diagnoses to consider include foreign body, tumor, perianal or perirectal abscess, rectal polyp, or engorged external hemorrhoids.
Reduction is usually accomplished with gentle manual pressure. If manual reductions fail, surgical consultation and operative reduction are needed. Surgical treatment is also indicated with a complete prolapse. All patients should undergo an anoscopic and sigmoidoscopic examination at some point; if rectal bleeding is a problem, full colonic evaluation should be completed.