Rectal Prolapse

Question 1

Define rectal prolapse

Answer 1

Protrusion of rectal tissue out of the anus (may be full thickness, mucosal or internal
intussuception)

Question 2

What are the causes/risk factors of a rectal prolapse?

Answer 2

Risk factors and associations
• Constipation/straining
• Pregnancy
• Previous surgery
• Pelvic floor dysfunction

Question 3

What are the symptoms of a rectal prolapse?

Answer 3

• Mass protruding from rectum
- Protrudes after bowel movement, straining, coughing, sneezing
- May spontaneously retract or require manual replacement
• Faecal incontinence/mucous discharge
• Constipation/tenesmus
• Rectal bleeding

Question 4

What are the signs of a rectal prolapse?

Answer 4

• Protruding rectal mass
• Thick concentric mucosal ring
• Sulcus between prolapsed rectum and anal canal

Question 5

What investigations are carried out for a rectal prolapse?

Answer 5

• Proctosigmoidoscopy - oedema of the rectal mucosa.
Used to investigate if there is ulceration or ischaemia.
• Defecating Proctogram - this is used to demonstrate a prolapse that couldn’t be produced on examination.
• Barium Enema - may show mucosal abnormalities e.g. Douglas Pouch
• Anal Sphincter Manometry - reduced sphincter pressure
• Pudendal Nerve Studies - cauda equina syndrome and nerve damage to the pudendal nerve.
• Sweat Chloride Test - in children, to reveal CF.