eMedicine Specialties > Emergency Medicine > Gastrointestinal

Rectal Prolapse

Author: Lynn K Flowers, MD, MHA, Assistant Professor, Department of Emergency Medicine, Emory School of Medicine; Clinical Faculty, Department of Emergency Medicine, Emory University Hospital
Contributor Information and Disclosures

Updated: Aug 9, 2007

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

References

  1. Abcarian H. Prolapse and procidentia. In: Zuidema GD, ed. Shackelford's Surgery of the Alimentary Tract. 4th ed. WB Saunders Co; 1996:368-85.

  2. Bartolo DC. Rectal prolapse. Br J Surg. Jan 1996;83(1):3-5. [Medline].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. Heine JA, Wong WD. Rectal prolapse. In: Mazier WP, ed. Surgery of the Colon, Rectum, and Anus. Harcourt Brace & Co; 1995:515-33.

  8. Hull TL, Milsom JW. Pelvic floor disorders. Surg Clin North Am. Dec 1994;74(6):1399-413. [Medline].

  9. Jacobs LK, Lin YJ, Orkin BA. The best operation for rectal prolapse. Surg Clin North Am. Feb 1997;77(1):49-70. [Medline].

  10. Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg. Jan 2005;140(1):63-73. [Medline].

  11. Siafakas C, Vottler TP, Andersen JM. Rectal prolapse in pediatrics. Clin Pediatr (Phila). Feb 1999;38(2):63-72. [Medline].

  12. 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

Contributor Information and Disclosures

Author

Lynn K Flowers, MD, MHA, Assistant Professor, Department of Emergency Medicine, Emory School of Medicine; Clinical Faculty, Department of Emergency Medicine, Emory University Hospital
Lynn K Flowers, MD, MHA is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eugene Hardin, MD, FACEP, FAAEM, Chair and Associate Professor, Department of Emergency Medicine, Charles R Drew University of Medicine and Science; Chair, Department of Emergency Medicine, Martin Luther King, Jr/Drew Medical Center
Eugene Hardin, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American College of Forensic Examiners
Disclosure: Nothing to disclose.

CME Editor

John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School
John Halamka, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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