Introduction
Background
Rectal prolapse occurs when a mucosal or full-thickness layer of rectal tissue slides through the anal orifice. Problems with fecal incontinence, constipation, and rectal ulceration are common.
Pathophysiology
Often, prolapse begins with an internal prolapse of the anterior rectal wall and progresses to full prolapse.
The precise cause of rectal prolapse is not defined; however, a number of associated abnormalities have been found. As many as 50% of prolapse cases are caused by chronic straining with defecation and constipation. A deep pouch of Douglas, weakness of the pelvic floor, and decreased resting anal sphincter pressure also have been associated with rectal prolapse.
In children, rectal prolapse is probably related to certain anatomical features such as the vertical orientation of the rectum, mobility of the sigmoid colon, relative weakness of the pelvic floor muscle, mucosa poorly fixed to submucosa, and redundant rectal mucosa.
Frequency
United States
Overall incidence is 4.2 cases per 1000 population. In persons older than 65 years, incidence is 10 cases per 1000 population.
Mortality/Morbidity
- Untreated rectal prolapse can lead to incarceration and strangulation (rare).
- More commonly, increasing difficulties with rectal bleeding (usually minor), ulceration, and incontinence occur.
Sex
In the adult population, the male-to-female ratio is 1:6. Although in adults women comprise 80-90% of cases, in the pediatric population, incidence is evenly distributed between males and females.
Age
- Although all ages can be affected, peak incidences are observed in the fourth and seventh decades of life.
- Pediatric patients usually are affected when younger than 3 years, with the peak incidence in the first year of life.
Clinical
History
- Constipation (15-65%)
- Fecal incontinence (28-88%)
- Mucus drainage
- Protruding anal mass
- Rectal bleeding
Physical
- Protruding rectal mucosa
- Thick concentric mucosal ring
- Sulcus noted between anal canal and rectum
- Solitary rectal ulcer (10-25%)
- Decreased anal sphincter tone
Causes
- Conditions with increased intra-abdominal pressure
- Constipation
- Diarrhea
- Benign prostatic hypertrophy
- Chronic obstructive pulmonary disease (COPD)
- Cystic fibrosis
- Pertussis (ie, whooping cough)
- Pelvic floor dysfunction
- Parasitic infections
- Amebiasis
- Schistosomiasis
- Anatomical features
- Deep cul-de-sac (ie, pouch of Douglas)
- Poor posterior fixation of rectum
- Redundant rectosigmoid
- Neurologic disorders
- Previous lower back or pelvic trauma/lumbar disk disease
- Cauda equina syndrome
- Spinal tumors
- Multiple sclerosis
More on Rectal Prolapse |
 Overview: Rectal Prolapse |
| Differential Diagnoses & Workup: Rectal Prolapse |
| Treatment & Medication: Rectal Prolapse |
| Follow-up: Rectal Prolapse |
| References |
| Next Page » |
References
Abcarian H. Prolapse and procidentia. In: Zuidema GD, ed. Shackelford's Surgery of the Alimentary Tract. 4th ed. WB Saunders Co; 1996:368-85.
Bartolo DC. Rectal prolapse. Br J Surg. Jan 1996;83(1):3-5. [Medline].
Boccasanta P, Rosati R, Venturi M, Montorsi M, Cioffi U, De Simone M, et al. Comparison of laparoscopic rectopexy with open technique in the treatment of complete rectal prolapse: clinical and functional results. Surg Laparosc Endosc. Dec 1998;8(6):460-5. [Medline].
Coburn WM 3rd, Russell MA, Hofstetter WL. Sucrose as an aid to manual reduction of incarcerated rectal prolapse. Ann Emerg Med. Sep 1997;30(3):347-9. [Medline].
Demirbas S, Ogün I, Celenk T, Akin ML, Erenoglu C, Yldz M. Early outcomes of laparoscopic procedures performed on military personnel with total rectal prolapse and follow-up. Surg Laparosc Endosc Percutan Tech. Aug 2004;14(4):194-200. [Medline].
Fengler SA, Pearl RK, Prasad ML, Orsay CP, Cintron JR, Hambrick E, et al. Management of recurrent rectal prolapse. Dis Colon Rectum. Jul 1997;40(7):832-4. [Medline].
Heine JA, Wong WD. Rectal prolapse. In: Mazier WP, ed. Surgery of the Colon, Rectum, and Anus. Harcourt Brace & Co; 1995:515-33.
Hull TL, Milsom JW. Pelvic floor disorders. Surg Clin North Am. Dec 1994;74(6):1399-413. [Medline].
Jacobs LK, Lin YJ, Orkin BA. The best operation for rectal prolapse. Surg Clin North Am. Feb 1997;77(1):49-70. [Medline].
Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg. Jan 2005;140(1):63-73. [Medline].
Siafakas C, Vottler TP, Andersen JM. Rectal prolapse in pediatrics. Clin Pediatr (Phila). Feb 1999;38(2):63-72. [Medline].
Williams JG, Madoff RD. Perineal repair for rectal prolapse. In: Problems in General Surgery. Vol 9. 1992:732-8.
Further Reading
Keywords
rectal prolapse, constipation, rectal pain, rectal bleeding, rectal ulceration, prolapsed rectum, fecal incontinence
