Rectal Prolapse

Question 1

What are the two types of rectal prolapse?

Answer 1

Partial thickness - rectal mucosa protrudes out of the anus

Full thickness - rectal wall protrudes out the anus

Question 2

What is the pathophysiology of a partial thickness prolapse?

Answer 2

Loosening and stretching of the connective tissue attaching rectal mucosa to the rectal wall

Associated with haemorrhoidal disease

Question 3

What is the pathophysiology of full prolapse?

Answer 3

Form of sliding hernia through fascial defect

Chronic straining secondary to constipation, chronic cough or multiple vaginal deliveries

Question 4

How does rectal prolapse present?

Answer 4

Rectal mucus discharge
Faecal incontinence
PR bleeding
Visible ulceration
Rectal fullness
Tenesmus

Question 5

If prolapse is not evident on examination what can be done?

Answer 5

Ask patient to strain

Question 6

How is rectal prolapse managed?

Answer 6

Conservative

Surgical
Only definitive management

Rectopexy