RECTAL PROLAPSE:

Rectal prolapse, or procidentia, represents an intussusception of the rectum. Its cause is unclear, but a redundant sigmoid colon and loss of rectal support and fixation are contributing factors. Prolapse may involve only the rectal mucosa (partial) or the full thickness of the rectum (complete).

RECTAL PROLAPSE IS CLASSIFIED AS FOLLOWS:

• Grade 1: occult prolapse.
• Grade 2: prolapse to the anus but not through it.
• Grade 3: protrusion through the anus for a variable distance.

SYMPTOMS AND PHYSICAL FINDINGS:

Patients may present with a protruding mass, a history of constipation and incontinence, bleeding, discharge, or a sensation of incomplete emptying. In patients with a grade 3 prolapse, physical examination reveals visible rectal tissue, which can be identified by its circumferential appearance Visualization of radial folds or the dentate line may indicate the presence of prolapsed internal hemorrhoids. When the diagnosis is suggested by the history but not confirmed by the physical examination, further studies may be necessary (ie, defecating proctography).

MANAGEMENT:

Treatment is surgical, via various abdominal or perineal procedures; the object is to prevent the sequelae of pudendal neuropathy, sphincter weakness, and fecal incontinence