Rectal prolapse: Difference between revisions
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==Background== | ==Background== | ||
[[File:Internalrectalintussusceptionexternalrectalprolapse.jpg|thumb|Internal rectal [[intussusception]] (A) vs external (complete) [[rectal prolapse]] (B).]] | |||
[[File:Rectum anatomy en.png|thumb|Anatomy of the anus and rectum.]] | |||
[[File:Internalrectalintussusceptionexternalrectalprolapse.jpg|thumb|Internal rectal [[Special:MyLanguage/intussusception|intussusception]] (A) vs external (complete) [[Special:MyLanguage/rectal prolapse|rectal prolapse]] (B).]] | |||
*Circumferential protrusion of part or all layers of the rectum through the anal canal | *Circumferential protrusion of part or all layers of the rectum through the anal canal | ||
*Complications are rare and include bleeding and ulceration | *Complications are rare and include bleeding and ulceration | ||
===Risk factors=== | ===Risk factors=== | ||
*Extremes of age | *Extremes of age | ||
*Chronic [[constipation]] | *Chronic [[Special:MyLanguage/constipation|constipation]] | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Full thickness rectal prolapse & mucosal prolapse..jpg|thumb|A. full thickness external rectal prolapse, and B. mucosal prolapse. Note circumferential arrangement of folds in full thickness prolapse compared to radial folds in mucosal prolapse.]] | [[File:Full thickness rectal prolapse & mucosal prolapse..jpg|thumb|A. full thickness external rectal prolapse, and B. mucosal prolapse. Note circumferential arrangement of folds in full thickness prolapse compared to radial folds in mucosal prolapse.]] | ||
[[File:Rectal prolaps.jpg|thumb|Complete (external) rectal prolapse. Note circumferential arrangement of mucosal folds.]] | [[File:Rectal prolaps.jpg|thumb|Complete (external) rectal prolapse. Note circumferential arrangement of mucosal folds.]] | ||
| Line 15: | Line 24: | ||
*Painful defecation (36%) | *Painful defecation (36%) | ||
*Fecal incontinence (38.7%) | *Fecal incontinence (38.7%) | ||
*[[Rectal bleeding]] (25.3%) | *[[Special:MyLanguage/Rectal bleeding|Rectal bleeding]] (25.3%) | ||
*[[Constipation]] (25.3%) | *[[Special:MyLanguage/Constipation|Constipation]] (25.3%) | ||
*Rectal ulcer (8%) | *Rectal ulcer (8%) | ||
:''Patients may mistake prolapsed mucosa for hemorrhoids'' | :''Patients may mistake prolapsed mucosa for hemorrhoids'' | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Anorectal DDX}} | {{Anorectal DDX}} | ||
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==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
===Types=== | ===Types=== | ||
#Prolapse involving the rectal mucosa only | #Prolapse involving the rectal mucosa only | ||
#*Rarely protrudes more than 2 to 3 cm beyond the anal verge | #*Rarely protrudes more than 2 to 3 cm beyond the anal verge | ||
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#*Sulcus may be palpated between the extruded bowel and anus | #*Sulcus may be palpated between the extruded bowel and anus | ||
#Intussusception of upper rectum into and through the lower rectum | #Intussusception of upper rectum into and through the lower rectum | ||
==Management== | ==Management== | ||
===Children=== | ===Children=== | ||
*Reduce via slow steady pressure applied to prolapsed segment | *Reduce via slow steady pressure applied to prolapsed segment | ||
*Prevent constipation | *Prevent constipation | ||
*Refer for evaluation of underlying condition ([[cystic fibrosis|CF]], pelvic floor weakness, [[diarrhea]]) | *Refer for evaluation of underlying condition ([[Special:MyLanguage/cystic fibrosis|CF]], pelvic floor weakness, [[Special:MyLanguage/diarrhea|diarrhea]]) | ||
===Adults=== | ===Adults=== | ||
*Reduction | *Reduction | ||
**Thumbs over luminal surfaces medially and fingers grasp outer walls laterally | **Thumbs over luminal surfaces medially and fingers grasp outer walls laterally | ||
| Line 54: | Line 77: | ||
*Difficult reduction | *Difficult reduction | ||
**Prolonged prolapse may lead to rectal wall edema | **Prolonged prolapse may lead to rectal wall edema | ||
**Adequate [[sedation]] and [[analgesia]] is key to successful reduction | **Adequate [[Special:MyLanguage/sedation|sedation]] and [[Special:MyLanguage/analgesia|analgesia]] is key to successful reduction | ||
***Can incorporate a [[perianal block]] in certain cases | ***Can incorporate a [[Special:MyLanguage/perianal block|perianal block]] in certain cases | ||
**Can place granulated sugar (not synthetic sweeteners) over prolapsed rectum | **Can place granulated sugar (not synthetic sweeteners) over prolapsed rectum | ||
***Wait 15 min for edema to subside and re-attempt | ***Wait 15 min for edema to subside and re-attempt | ||
*Failed reduction | *Failed reduction | ||
**Obtain emergent surgical consultation | **Obtain emergent surgical consultation | ||
==Disposition== | ==Disposition== | ||
*Discharge | *Discharge | ||
*Refer all patients for colonoscopy and surgeon for consideration of repair | *Refer all patients for colonoscopy and surgeon for consideration of repair | ||
==See Also== | ==See Also== | ||
*[[Anorectal disorders]] | |||
*[[Special:MyLanguage/Anorectal disorders|Anorectal disorders]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
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Latest revision as of 23:56, 4 January 2026
Background
- Circumferential protrusion of part or all layers of the rectum through the anal canal
- Complications are rare and include bleeding and ulceration
Risk factors
- Extremes of age
- Chronic constipation
Clinical Features
Most frequent complaint at the time of clinical presentation:[1]
- Sensation of a protruding rectal mass (98.7%)
- Painful defecation (36%)
- Fecal incontinence (38.7%)
- Rectal bleeding (25.3%)
- Constipation (25.3%)
- Rectal ulcer (8%)
- Patients may mistake prolapsed mucosa for hemorrhoids
Differential Diagnosis
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Coccydynia
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Fecal impaction
- Hemorrhoids
- Levator ani syndrome
- Pedunculated polyp
- Pilonidal cyst
- Proctalgia fugax
- Proctitis
- Pruritus ani
- Enterobius (pinworms)
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Non-GI Look-a-Likes
Evaluation
- Clinical diagnosis
Types
- Prolapse involving the rectal mucosa only
- Rarely protrudes more than 2 to 3 cm beyond the anal verge
- Anal edges appear everted
- Radially directed folds
- No sulcus between extruded mucosa and anus
- Frequently associated with 3rd and 4th degree hemorrhoids
- Prolapse involving all layers of the rectum
- May protrude up to 15 cm
- Anus appears normal
- Prolapse appears as red, ball-like mass with concentric folds
- Sulcus may be palpated between the extruded bowel and anus
- Intussusception of upper rectum into and through the lower rectum
Management
Children
- Reduce via slow steady pressure applied to prolapsed segment
- Prevent constipation
- Refer for evaluation of underlying condition (CF, pelvic floor weakness, diarrhea)
Adults
- Reduction
- Thumbs over luminal surfaces medially and fingers grasp outer walls laterally
- Apply continuous pressure first with thumbs followed by internal rolling of fingers
- After reduction perform digital rectal exam to evaluate for rectal mass/polyp
- Thumbs over luminal surfaces medially and fingers grasp outer walls laterally
- Difficult reduction
- Prolonged prolapse may lead to rectal wall edema
- Adequate sedation and analgesia is key to successful reduction
- Can incorporate a perianal block in certain cases
- Can place granulated sugar (not synthetic sweeteners) over prolapsed rectum
- Wait 15 min for edema to subside and re-attempt
- Failed reduction
- Obtain emergent surgical consultation
Disposition
- Discharge
- Refer all patients for colonoscopy and surgeon for consideration of repair
See Also
References
- ↑ Hammond K, et al. Rectal Prolapse: A 10-Year Experience. J. 2007 Spring; 7(1): 24–32. PMCID: PMC3096348