rectum. Partial prolapse involves only the mucosa and usually only protrudes by a
few centimetres. Complete prolapse involves all layers of the rectal wall.
More advanced rectal prolapses may occur when standing and so greatly
interfere with the patient's quality of life.
Epidemiology
It is most common in the elderly but can occur in all ages, including children.
[1]
Risk factors
Previous surgery.[5]
Neurological disease - eg, previous lower back or pelvic trauma, lumbar disc
disease, cauda equina syndrome, spinal tumours, multiple sclerosis. [5]
Psychiatric disease.[8]
Initially only after a bowel movement and usually retracts when the
patient stands up.
Later the mass protrudes more often, especially with straining and
Valsalva manoeuvres such as sneezing or coughing.
Finally, the rectum prolapses with daily activities such as walking and
may progress to continual prolapse.
may occur.
Examination may also reveal a rectal ulcer and decreased anal sphincter
tone.
Differential diagnosis
Investigations
Associated diseases
Management
Rectal prolapse can usually be reduced with gentle digital pressure. Sedation
and local perianal anaesthesia may help the reduction.
Conservative treatment
Elderly: often well tolerated and concealed with the patient manually reducing
the prolapse. In those unfit for surgery, a subcutaneous circumanal rubber ring
may be fitted. However, this often fails either because it is too tight or too loose,
resulting in constipation or recurrent prolapse.
Surgical treatment
Abdominal procedures:[8]
Abdominal procedures are preferred for all patients fit for abdominal
surgery.
Perineal procedures:[13]
Complications
Mucosal ulceration.[21]
Prognosis
The prognosis for elderly patients presenting with rectal prolapse is variable
and depends on the nature of any underlying or associated problems and the
age and general well-being of the patient.
Of the children with rectal prolapse who are aged 9 months to 3 years, 90%
will need only conservative treatment. For children who first experience prolapse
when older than 4 years, a much lower rate of spontaneous resolution occurs.
[18]
Provide Feedback
Further reading & references
Lee JL, Yang SS, Park IJ, et al; Comparison of abdominal and perineal
procedures for complete rectal prolapse: an analysis of 104 patients. Ann Surg
Treat Res. 2014 May;86(5):249-55. doi: 10.4174/astr.2014.86.5.249. Epub 2014
Apr 24.
1.
2.
3.
4.
Goldstein SD, Maxwell PJ 4th; Rectal prolapse. Clin Colon Rectal Surg. 2011
Mar;24(1):39-45. doi: 10.1055/s-0031-1272822.
5.
6.
7.
AlGhamdi HM, Parashar SA, Kawaja S, et al; Rectal prolapse associated with
extensive anorectal condyloma acuminata. Saudi J Gastroenterol. 2009
Jan;15(1):62. doi: 10.4103/1319-3767.45064.
8.
9.
Cho HM; Anorectal physiology: test and clinical application. J Korean Soc
Coloproctol. 2010 Oct;26(5):311-5. doi: 10.3393/jksc.2010.26.5.311. Epub 2010
Oct 31.
10.
11.
12.
Tjandra JJ, Chan MK; Systematic review on the procedure for prolapse and
hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum. 2007
Jun;50(6):878-92.
13.
14.
Ris F, Colin JF, Chilcott M, et al; Altemeier's procedure for rectal prolapse:
analysis of long-term outcome in 60 patients. Colorectal Dis. 2012
Sep;14(9):1106-11. doi: 10.1111/j.1463-1318.2011.02904.x.
15.
Sajid MS, Siddiqui MR, Baig MK; Open vs laparoscopic repair of full-thickness
rectal prolapse: a re-meta-analysis. Colorectal Dis. 2010 Jun;12(6):515-25. doi:
10.1111/j.1463-1318.2009.01886.x.
16.
17.
Laituri CA, Garey CL, Fraser JD, et al; 15-Year experience in the treatment of
rectal prolapse in children. J Pediatr Surg. 2010 Aug;45(8):1607-9. doi:
10.1016/j.jpedsurg.2010.01.012.
18.
Flum AS, Golladay ES, Teitelbaum DH; Recurrent rectal prolapse following
primary surgical treatment. Pediatr Surg Int. 2010 Apr;26(4):427-31. doi:
10.1007/s00383-010-2565-x. Epub 2010 Feb 21.
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