RECTAL PROLAPSE

Rectal prolapse may be partial (mucosal) or complete (whole thickness of rectal wall). It is a common occurrence in children and the elderly (especially females, who form 85% of affected adults population) but may occur at any age

Clinical Features

Clinically there are three types, categorized as follows:

  • Primary prolapse with spontaneous reduction.
  • Secondary prolapse with manual reduction.
  • Tertiary prolapse that is irreducible.

Most patients present with reducible prolapse, which often occurs during defecation and is associated with discomfort, bleeding, and mucus discharge.
Prolapse may also be caused by mild exertion (e.g., through cough or walking) and may also be associated with incontinence of flatus and faeces. When uterine prolapse compounds rectal prolapse, urinary incontinence may also be a feature.

Rectal prolapse is also associated with benign prostatic hypertrophy, constipation, malnutrition, old age, and homosexuality/anal intercourse. Anorectal carcinomas should always be suspected if there are also ulcers, indurations, or masses in this area. During clinical examination it is important to check for
patulous anus and for poor sphincter tone (on digital examination).

MANAGEMENT

  • Refer all suspected patients
  • May be conservative or operative, depending on the patient.
  • Primary and secondary prolapse: conservative treatment with stool softeners, e.g., lactulose 15ml 12 hourly.
  • Tertiary prolapse – Refer for definitive surgery.
  • Complications include irreducibility of the prolapse with ulceration, bleeding, gangrene, and possible rupture of the bowel.