Rectal prolapse, also called rectal procidentia, occurs when anorectal tissue protrudes through the anus. Prolapse may be partial, involving only the mucosa, or complete, involving all layers of the rectal wall. Prolapse may result from laxity of the pelvic floor, weak anal sphincters, or lack of mesorectal fixation. Patients are often at extremes of age and may present with altered bowel habits, rectal mass, straining with bowel movements, and mucus discharge. Risk factors include multiparity, vaginal delivery, chronic constipation, and cystic fibrosis. Rectal prolapse is typically painless. Pain as a presenting symptom should prompt consideration of other diagnoses, such as rectal foreign body, neoplastic process, anorectal abscess, rectal polyp, or external hemorrhoids.
Management and Disposition
Firm persistent manual pressure will reduce most cases. Granulated sugar may be applied to the prolapsed tissue as an osmotic agent to reduce edema to aid reduction. If manual reduction fails, surgical consultation and operative reduction are indicated. Surgical consultation is also indicated with a complete prolapse. Refer all patients for anoscopic and sigmoidoscopic examination to evaluate for secondary causes.
Rectal prolapse is commonly seen in children with cystic fibrosis. All children with rectal prolapse should undergo a sweat chloride test.
Examination of rectal prolapse reveals concentric mucosal rings and a sulcus between the anal canal and the rectum. Prolapsed hemorrhoids are separated by radial grooves and the sulcus is absent.
Prolapsed Rectum. The rectum is completely prolapsed in this elderly patient. (Photo contributor: Alan B. Storrow, MD.)
Prolapsed Rectum. Recurrent rectal prolapse due to chronic constipation. (Photo contributor: Lawrence B. Stack, MD.)
Prolapsed Rectum—Infant. Two-month-old with rectal prolapse after repeated episodes of straining at stool. Rectal biopsy performed because of abnormal barium enema. Biopsy results negative for Hirschsprung disease. (Photo contributor: Lawrence B. Stack, MD.)
Prolapsed Rectum. Large, complete, nonedematous rectal prolapse in a nursing home patient with recurrent prolapse. (Photo contributor: Kevin J. Knoop, MD, MS.)
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Video 09-01: Rectal Prolapse with Sugar Application
(Video Contributor: Lawrence B. Stack, MD)