II. Definitions
- Rectal Prolapse
- Protrusion of all or some layers of the Rectum via the anus with straining
- Intussception of the bowel through the anus
III. Epidemiology
- Bimodal distribution: Pediatric and Elderly patients
IV. Pathophysiology
- Weak pelvic support
V. Types
- Full thickness Rectal Prolapse
- Internal prolapse (Internal Intussusception
- Prolapse not visible outside the anal canal
- Mucosal prolapse
- Progression of Hemorrhoids more than a pelvic support disorder
VI. Risk Factors
- Chronic Constipation
- Conditions predisposing to straining at stool (e.g. Multiple pregnancies)
- Increasing Age (esp. women)
VII. Symptoms
- Mass protruding from the anus
- Onset often after straining to stool
- Associated symptoms
- Rectal Pain
- Anal Discharge
- Rectal Bleeding
VIII. Associated Conditions
- Pelvic Organ Prolapse (e.g. Rectocele, Cystocele)
- Hemorrhoids (especially with mucosal prolapse)
IX. Complications
- Incarcerated Hernia (rare)
- Tissue breakdown and necrosis of incarcerated bowel
X. Management: Manual Reduction
- Contraindications
- Tissue necrosis
- Adjuncts
- Technique
- Avoid delays due to risks of prolonged prolapse with tissue breakdown and necrosis risk
- Patient lies in lateral decubitus position or prone position
- Apply granulated sugar or gauze soaked in sugar water over prolapsed mucosa for 10 to 20 minutes
- Assistant retracts the buttock cheeks
- Examiner applies both thumbs against the central opening, and other fingers resting against the buttocks
- Thumbs apply constant gentle pressure
- Fingers apply circumferential pressure, rotating the hands clockwise and counterclockwise
- Maintain over several minutes as the prolapse reduces
- Apply a pressure dressing against the anus to prevent a short-term recurrence
- First layer against the anus may be Vaseline Gauze
XI. Management: Other Measures
- Surgery Indications
- Failed reduction
- Incarcerated Hernia
- Disposition
- Follow-up for evaluation for malignancy (nidus for prolapse)
XII. Prevention
- Pelvic Floor Exercises
- Avoid straining at stool
- Follow bowel regimen to maintain soft stools
XIII. Resources
XIV. References
- Warrington (2022) Crit Dec Emerg Med 36(7): 15
- Cohee (2020) Am Fam Physician 101(1):24-33 [PubMed]
- Jones (2011) BMJ 342:c7099 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | Protrusion of the rectal mucous membrane through the anus. There are various degrees: incomplete with no displacement of the anal sphincter muscle; complete with displacement of the anal sphincter muscle; complete with no displacement of the anal sphincter muscle but with herniation of the bowel; and internal complete with rectosigmoid or upper rectum intussusception into the lower rectum. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D012005 |
| ICD9 | 569.1 |
| ICD10 | K62.3 |
| SnomedCT | 155802002, 197214005, 197215006, 197212009, 57773001 |
| English | Prolapse, Rectal, Prolapses, Rectal, Rectal Prolapses, Rectal prolapse NOS, RECTAL PROLAPSE, Rectal Prolapse, rectal prolapse (diagnosis), rectal prolapse (physical finding), rectal prolapse, rectal prolapse was observed, Prolapse of rectal mucosa, Rectal Prolapse [Disease/Finding], Prolapse;rectal, rectum prolapse, prolapse rectal, prolapse rectum, Rectal prolapsed, Rectal prolapse NOS (disorder), Rectum--Prolapse, Rectal prolapse, Procidentia of rectum, Rectal mucosa prolapse, RP - Rectal prolapse, Rectal prolapse (disorder), prolapse; rectum, rectum; prolapse, Rectal prolapse [Ambiguous], Procidentia, rectum |
| French | PROLAPSUS RECTAL, Prolapsus rectal, Prolapsus du rectum |
| Japanese | 直腸脱, ﾁｮｸﾁｮｳﾀﾞﾂ |
| Swedish | Ändtarmsframfall |
| Czech | rektum - prolaps, Prolaps konečníku, rektální prolaps |
| Finnish | Peräsuolen esiinluiskahdus |
| Russian | PRIAMOI KISHKI VYPADENIE, ANUSA VYPADENIE, АНУСА ВЫПАДЕНИЕ, ПРЯМОЙ КИШКИ ВЫПАДЕНИЕ |
| Portuguese | PROLAPSO RECTAL, Prolapso rectal, Prolapso Retal |
| Korean | 직장 탈출 |
| Polish | Wypadanie odbytu, Wypadanie odbytnicy |
| Hungarian | Rectalis prolapsus |
| Norwegian | Rektumprolaps, Endetarmsfremfall, Endetarmsprolaps, Rectumprolaps |
| Spanish | prolapso rectal, SAI, prolapso rectal, SAI (trastorno), prolapso de mucosa rectal, prolapso rectal (trastorno), prolapso rectal, Prolapso rectal, Prolapso Rectal |
| Dutch | prolaps; rectum, rectum; prolaps, rectumprolaps, Prolaps, rectum-, Rectumprolaps |
| German | Rektumprolaps |
| Italian | Prolasso rettale |
