Rectal prolapse is a condition where the rectum (part of the large intestine) protrudes through the anal canal. It can be partial (mucosal) or complete (full-thickness). It is more common in elderly women but can occur in children as well.
📌 Types of Rectal Prolapse
- 1. Mucosal prolapse – only the rectal mucosa protrudes (common in children).
- 2. Complete (full-thickness) prolapse – the entire wall of rectum protrudes through anus.
- 3. Internal prolapse (intussusception) – rectum telescopes inside itself but does not protrude externally.
🔎 Etiology & Risk Factors
- Chronic constipation, straining.
- Weak pelvic floor muscles.
- Neurological disorders (spinal cord injury, multiple sclerosis).
- Chronic cough, COPD.
- Multiparity, lax anal sphincter (in elderly women).
⚕️ Clinical Features
Symptoms:
- Mass protruding per anus (increases on straining, cough, walking).
- Fecal incontinence or mucus discharge.
- Constipation or obstructed defecation.
- Bleeding per rectum (if ulceration).
Signs:
- Concentric folds (full-thickness prolapse) vs radial folds (mucosal prolapse).
- Associated sphincter weakness.
- Prolapse may be reducible initially, later irreducible.
🧪 Diagnosis
- Clinical examination is usually diagnostic.
- Proctoscopy/sigmoidoscopy → exclude polyps, carcinoma.
- Colonoscopy → if older patient or alarm features.
- Defecography / dynamic MRI → assess internal prolapse, pelvic floor disorders.
- Anorectal manometry → assess sphincter function in incontinence.
💊 Management
1. Conservative (for children, mild cases, unfit for surgery):
- High-fiber diet, stool softeners, laxatives.
- Pelvic floor exercises.
- Treat underlying constipation.
- Most children <4 years improve with conservative care.
2. Surgical Treatment (definitive in adults):
- Perineal procedures (preferred in elderly/unfit patients):
- Delorme’s procedure (mucosal sleeve resection, plication of muscle).
- Altemeier’s procedure (perineal rectosigmoidectomy).Abdominal procedures (preferred in younger/fit patients):
- Rectopexy (open/laparoscopic): fixation of rectum to sacrum, with or without resection (resection rectopexy if redundant sigmoid).
- Mesh or suture rectopexy.
- Laparoscopic rectopexy is now the gold standard for many patients.
⚠️ Complications
- Ulceration, bleeding.
- Irreducible prolapse, strangulation, gangrene (rare).
- Fecal incontinence.
- Recurrence after surgery (higher in perineal procedures).
