Skip to Main Content

++

Rectal prolapse is an uncommon condition. It was first described in the Bible (2 Chronicles 21). “You yourself will be very ill with a lingering disease of the bowels, until the disease causes your bowels to come out. . After all this, the Lord afflicted Jehoram with an incurable disease of the bowels. In the course of time, at the end of the second year, his bowels came out because of the disease, and he died in great pain.” The pathophysiology of a rectal prolapse has been evolving since 1543 when Vesalius described the detailed anatomy of the anorectum. Today, three types of rectal prolapse are recognized and they represent three stages of a continuum.1

++

Rectal prolapse usually affects people at the extremes of age. It is most common in the very young and the elderly. The condition usually manifests itself in children within the first 4 years of life, with the highest incidence occurring in the first year.2 The gender incidence is equal or slightly weighted toward males.1 The peak incidence in the elderly is approximately between 60 and 70 years of age. It affects primarily women, with a 6 : 1 ratio of females to males.3

++

A rectal prolapse is classified into one of three stages (Figure 58-1). An internal prolapse is the prolapse of the upper rectum and sigmoid colon into the rectal ampulla (Figure 58-1A). It is also known as a hidden or occult prolapse. This type of prolapse does not emerge through the anus. Mucosal prolapse is more common in children. It results from the loose attachment of the mucosa to the submucosal layers and an associated weakness of the anal sphincter. A mucosal prolapse is diagnosed by the presence of radial folds and the absence of muscular wall.3

++
FIGURE 58-1
Graphic Jump Location

Types of rectal prolapse. A. Midsagittal view of the internal, hidden, or occult prolapse. B. Midsagittal view of the incomplete, mucosal, or partial prolapse. C. Posterior view of the incomplete, mucosal, or partial prolapse. D. Midsagittal view of the complete prolapse or procidentia. E. Posterior view of the complete prolapse or procidentia.

++

If the condition progresses, it leads to the protrusion of part or all layers of the rectum through the anal orifice. If only the mucosa is prolapsed, it is classified as an incomplete prolapse (Figures 58-1B and C). Synonyms include mucosal prolapse and partial prolapse. A complete rectal prolapse occurs when all bowel layers, including the muscular wall, are involved (Figures 58-1D and E). This condition is also known as a procidentia. The complete rectal prolapse is more common in the elderly. It results from generalized weakening of the pelvic floor and anal sphincter muscles. A complete rectal prolapse is characterized by the presence of concentric folds. A ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessEmergency Medicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.