Rectal prolapse

Question 1

Define rectal prolapse

Answer 1

Abnormal protrusion of the full thickness (or only mucosal layer) of rectum through the anus

Question 2

Aetiology of rectal prolapse

2

Answer 2

Straining
Abnormal rectal anatomy or physiology - pelvic floor weakness, poor fixation of rectum to scrum or reduced anal sphincter pressure

Question 3

Risk factors of rectal prolapse

5

Answer 3

Constipation
Causes of increased straining 
Cystic fibrosis (in children)
Previous trauma to anus/perineum
Neurological conditions (e.g. cauda equina syndrome, MS)

Question 4

Epidemiology of rectal prolapse

prevalence, ages

Answer 4

Relatively COMMON

Most commonly affects children (<3 yrs) & elderly

Question 5

Presenting symptoms of rectal prolapse

7

Answer 5

Protruding anal mass
Initially associated w/ defecation
May require digital replacement
Constipation
Faecal incontinence 
PR mucus or bleeding
May be EMERGENCY - irreducible or strangulated prolapse

Question 6

Signs of rectal prolapse on physical examination

3

Answer 6

Prolapse may be seen on straining
May be ulcerated or necrotic if vascular supply is compromised
Reduced anal sphincter tone