II. Definitions

  1. Rectal Prolapse
    1. Protrusion of all or some layers of the Rectum via the anus with straining
    2. Intussception of the bowel through the anus

III. Epidemiology

  1. Bimodal distribution: Pediatric and Elderly patients

IV. Pathophysiology

  1. Weak pelvic support

V. Types

  1. Full thickness Rectal Prolapse
  2. Internal prolapse (Internal Intussusception
    1. Prolapse not visible outside the anal canal
  3. Mucosal prolapse
    1. Progression of Hemorrhoids more than a pelvic support disorder

VI. Risk Factors

  1. Chronic Constipation
  2. Conditions predisposing to straining at stool (e.g. Multiple pregnancies)
  3. Increasing Age (esp. women)

VII. Symptoms

  1. Mass protruding from the anus
    1. Onset often after straining to stool
  2. Associated symptoms
    1. Rectal Pain
    2. Anal Discharge
    3. Rectal Bleeding

VIII. Associated Conditions

  1. Pelvic Organ Prolapse (e.g. Rectocele, Cystocele)
  2. Hemorrhoids (especially with mucosal prolapse)

IX. Complications

  1. Incarcerated Hernia (rare)
  2. Tissue breakdown and necrosis of incarcerated bowel

X. Management: Manual Reduction

  1. Contraindications
    1. Tissue necrosis
  2. Adjuncts
    1. Applying granulated sugar to rectal mucosa reduces local edema
    2. Anxiolysis (e.g. Midazolam)
    3. Analgesia (e.g. Fentanyl)
  3. Technique
    1. Avoid delays due to risks of prolonged prolapse with tissue breakdown and necrosis risk
    2. Patient lies in lateral decubitus position or prone position
    3. Apply granulated sugar or gauze soaked in sugar water over prolapsed mucosa for 10 to 20 minutes
    4. Assistant retracts the buttock cheeks
    5. Examiner applies both thumbs against the central opening, and other fingers resting against the buttocks
      1. Thumbs apply constant gentle pressure
      2. Fingers apply circumferential pressure, rotating the hands clockwise and counterclockwise
      3. Maintain over several minutes as the prolapse reduces
    6. Apply a pressure dressing against the anus to prevent a short-term recurrence
      1. First layer against the anus may be Vaseline Gauze

XI. Management: Other Measures

  1. Surgery Indications
    1. Failed reduction
    2. Incarcerated Hernia
  2. Disposition
    1. Follow-up for evaluation for malignancy (nidus for prolapse)

XII. Prevention

  1. Pelvic Floor Exercises
  2. Avoid straining at stool
    1. Follow bowel regimen to maintain soft stools

XIV. References

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Related Studies

Ontology: Rectal Prolapse (C0034888)

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, チョクチョウダツ
Swedish Ändtarmsframfall
Czech rektum - prolaps, Prolaps konečníku, rektální prolaps
Finnish Peräsuolen esiinluiskahdus
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