Rectal Prolapse Workup

  • Author: Lisa Susan Poritz, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Apr 20, 2010
 

Laboratory Studies

  • The only pertinent laboratory studies are those dictated by the patient's age and comorbidities. No specific tests aid in evaluation of rectal prolapse.
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Imaging Studies

  • Barium enema: Evaluate the entire colon prior to surgery for rectal prolapse to exclude any other colonic lesions that should be simultaneously addressed. Evaluation can be accomplished by colonoscopy or barium enema. Barium enema is a better indicator of the redundancy of the colon.
  • Video defecography: This examination is used to help document internal prolapse or to distinguish rectal prolapse from mucosal prolapse if it is not clinically obvious. Defecography is not necessary for clinically diagnosed full-thickness rectal prolapse. Radiopaque material (usually barium paste) is instilled into the rectum, and the patient is asked to defecate on a radiolucent toilet. Spot films and videotapes are made and can be used to determine if the rectum intussuscepts on defecation.
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Other Tests

  • Anal rectal manometry is sometimes used to evaluate the anal sphincter muscles. In almost all patients, the results show a decrease in resting pressure in the internal sphincter and an absence of the anorectal inhibitory reflex. The significance of these results is unclear, and most surgeons do not use this test.
  • Sitz marker study: This test is occasionally used to measure colonic transit in a patient with constipation and rectal prolapse to help determine the need for colonic resection.
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Diagnostic Procedures

  • Rigid proctosigmoidoscopy should be performed to assess the rectum for additional lesions, especially solitary rectal ulcers. These ulcers are present in about 10-25% of patients with either internal or full-thickness prolapse. If present, the area appears as a single ulcer or as multiple ulcers on the anterior rectal wall. The edges are often heaped up, and the area may be bleeding. Biopsies should be taken to confirm the diagnosis and to exclude other pathology.
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Histologic Findings

Solitary rectal ulcers can usually be identified by an experienced pathologist. The prolapsed rectum may have ulcerated mucosa but is otherwise histologically normal.

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Contributor Information and Disclosures
Author

Lisa Susan Poritz, MD  Associate Professor of Surgery and Cellular and Molecular Physiology, Director, Colon and Rectal Research, Department of Surgery, Division of Colon and Rectal Surgery, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine

Lisa Susan Poritz, MD is a member of the following medical societies: American College of Surgeons, American Physiological Society, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, Association of Women Surgeons, Central Surgical Association, Society for Surgery of the Alimentary Tract, and Society of University Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Brian James Daley, MD, MBA, FACS, FCCP, CNSC  Professor, Associate Program Director, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee Health Science Center College of Medicine

Brian James Daley, MD, MBA, FACS, FCCP, CNSC is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David L Morris, MD, PhD, FRACS  Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

References

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Rectal prolapse.
Full-thickness rectal prolapse.
Marlex rectopexy.
Delorme mucosal sleeve resection.
Altemeier perineal rectosigmoidectomy.
 
 
 
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