Rectal prolapse: Difference between revisions
(Created page with "==Background== *Circumferential protrusion of part or all layers of the rectum through the anal canal *Risk factors **Extremes of age **Chronic constipation *3 types: **1. Prolap...") |
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**Extremes of age | **Extremes of age | ||
**Chronic constipation | **Chronic constipation | ||
* | *Types: | ||
**1. Prolapse involving the rectal mucosa only | **1. 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 | ||
Line 19: | Line 19: | ||
==Clinical Features== | ==Clinical Features== | ||
*Irritation to mucosa caused by recurrent prolapse results in mucous | *Irritation to mucosa caused by recurrent prolapse results in mucous discharge and bleeding | ||
* | *Anal sphincter weakness may result in fecal incontinence | ||
*In children, parents often | *In children, parents often mistake prolapsed mucosa for hemorrhoids | ||
==Treatment== | ==Treatment== | ||
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##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 | ##Refer for evaluation of underlying condition (CF, pelvic floor weakness, diarrhea) | ||
#Adults | #Adults | ||
##Reduction | ##Reduction |
Revision as of 15:54, 24 March 2012
Background
- Circumferential protrusion of part or all layers of the rectum through the anal canal
- Risk factors
- Extremes of age
- Chronic constipation
- Types:
- 1. 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 w/ 3rd and 4th degree hemorrhoids
- 2. Prolapse involving all layers of the rectum
- May protrude up to 15cm
- Anus appears normal
- Prolapse appears as red, ball-like mass w/ concentric folds
- Sulcus may be palpated between the extruded bowel and anus
- 3. Intussusception of upper rectum into and through the lower rectum
- 1. Prolapse involving the rectal mucosa only
Clinical Features
- Irritation to mucosa caused by recurrent prolapse results in mucous discharge and bleeding
- Anal sphincter weakness may result in fecal incontinence
- In children, parents often mistake prolapsed mucosa for hemorrhoids
Treatment
- 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 w/ 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
- Can place granulated sugar (not synthetic sweeteners) over prolapsed rectum
- Wait 15min for edema to subside and re-attempt
- Failed reduction
- Obtain emergent surgical consultation
- Refer all pts for colonoscopy and to a surgeon for consideration of repair
- Reduction
Source
Tintinalli