Rectal prolapse is painless protrusion of the rectum through the anus. Procidentia is complete prolapse of the entire thickness of the rectum. Diagnosis is by inspection. Surgery is usually required in adults.
(See also Evaluation of Anorectal Disorders.)
Transient, minor prolapse of just the rectal mucosa often occurs in otherwise normal infants. Mucosal prolapse in adults persists and may progressively worsen.
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Procidentia is complete prolapse of the entire thickness of the rectum. The primary cause of procidentia is unclear. Most patients are women > 60.
Symptoms and Signs of Rectal Prolapse and Procidentia
The most prominent symptom of rectal prolapse and procidentia is protrusion. It may only occur while straining or while walking or standing.
Rectal bleeding can occur, and incontinence is frequent. Pain is uncommon unless incarceration or significant prolapse occurs.
Diagnosis of Rectal Prolapse and Procidentia
Clinical evaluation
Sigmoidoscopy, colonoscopy, or barium enema
To determine the full extent of the prolapse, the clinician should examine the patient while the patient is standing or squatting and straining. Rectal procidentia can be distinguished from hemorrhoids by the presence of circumferential mucosal folds. Anal sphincter tone is usually diminished.
Sigmoidoscopy, colonoscopy, or barium enema x-rays of the colon must be done to search for other disease.
Primary neurologic disorders (eg, spinal cord tumors) should be considered.
Treatment of Rectal Prolapse and Procidentia
Elimination of causes of straining
For infants and children: Sometimes strapping buttocks together
For adults: Usually surgery
(See also the American Society of Colon and Rectal Surgeons' 2017 clinical practice guidelines for the treatment of rectal prolapse.)
In infants and children, conservative treatment is most satisfactory. Causes of straining should be eliminated. Firmly strapping the buttocks together with tape between bowel movements usually facilitates spontaneous resolution of the prolapse.
For simple mucosal prolapse in adults, the excess mucosa can be excised.
For procidentia, rectopexy, in which the rectum is mobilized and fixed to the sacrum, may be required in patients who can tolerate a laparotomy. In patients who cannot tolerate a laparotomy, perineal operations (eg, Delorme or Altemeier procedure) can be considered.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
American Society of Colon and Rectal Surgeons: Clinical practice guidelines for the treatment of rectal prolapse (2017)
