Rectal prolapse: Difference between revisions
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==Background== | ==Background== | ||
[[File:Rectum anatomy en.png|thumb|Anatomy of the anus and rectum.]] | |||
[[File:Internalrectalintussusceptionexternalrectalprolapse.jpg|thumb|Internal rectal [[intussusception]] (A) vs external (complete) [[rectal prolapse]] (B).]] | |||
*Circumferential protrusion of part or all layers of the rectum through the anal canal | *Circumferential protrusion of part or all layers of the rectum through the anal canal | ||
*Complications are rare and include bleeding and ulceration | |||
===Risk factors=== | ===Risk factors=== | ||
*Extremes of age | *Extremes of age | ||
*Chronic constipation | *Chronic [[constipation]] | ||
==Clinical Features== | |||
[[File:Full thickness rectal prolapse & mucosal prolapse..jpg|thumb|A. full thickness external rectal prolapse, and B. mucosal prolapse. Note circumferential arrangement of folds in full thickness prolapse compared to radial folds in mucosal prolapse.]] | |||
[[File:Rectal prolaps.jpg|thumb|Complete (external) rectal prolapse. Note circumferential arrangement of mucosal folds.]] | |||
Most frequent complaint at the time of clinical presentation:<ref>Hammond K, et al. Rectal Prolapse: A 10-Year Experience. J. 2007 Spring; 7(1): 24–32. PMCID: PMC3096348</ref> | |||
*Sensation of a protruding rectal mass (98.7%) | |||
*Painful defecation (36%) | |||
*Fecal incontinence (38.7%) | |||
*[[Rectal bleeding]] (25.3%) | |||
*[[Constipation]] (25.3%) | |||
*Rectal ulcer (8%) | |||
:''Patients may mistake prolapsed mucosa for hemorrhoids'' | |||
==Differential Diagnosis== | |||
{{Anorectal DDX}} | |||
==Evaluation== | |||
*Clinical diagnosis | |||
===Types=== | ===Types=== | ||
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#*Frequently associated with 3rd and 4th degree hemorrhoids | #*Frequently associated with 3rd and 4th degree hemorrhoids | ||
#Prolapse involving all layers of the rectum | #Prolapse involving all layers of the rectum | ||
#*May protrude up to | #*May protrude up to 15 cm | ||
#*Anus appears normal | #*Anus appears normal | ||
#*Prolapse appears as red, ball-like mass with concentric folds | #*Prolapse appears as red, ball-like mass with concentric folds | ||
#*Sulcus may be palpated between the extruded bowel and anus | #*Sulcus may be palpated between the extruded bowel and anus | ||
#Intussusception of upper rectum into and through the lower rectum | #Intussusception of upper rectum into and through the lower rectum | ||
==Management== | ==Management== | ||
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*Reduce via slow steady pressure applied to prolapsed segment | *Reduce via slow steady pressure applied to prolapsed segment | ||
*Prevent constipation | *Prevent constipation | ||
*Refer for evaluation of underlying condition (CF, pelvic floor weakness, diarrhea) | *Refer for evaluation of underlying condition ([[cystic fibrosis|CF]], pelvic floor weakness, [[diarrhea]]) | ||
===Adults=== | ===Adults=== | ||
| Line 41: | Line 55: | ||
*Difficult reduction | *Difficult reduction | ||
**Prolonged prolapse may lead to rectal wall edema | **Prolonged prolapse may lead to rectal wall edema | ||
**Adequate sedation and analgesia is key to successful reduction | **Adequate [[sedation]] and [[analgesia]] is key to successful reduction | ||
***Can incorporate a [[perianal block]] in certain cases | |||
**Can place granulated sugar (not synthetic sweeteners) over prolapsed rectum | **Can place granulated sugar (not synthetic sweeteners) over prolapsed rectum | ||
***Wait | ***Wait 15 min for edema to subside and re-attempt | ||
*Failed reduction | *Failed reduction | ||
**Obtain emergent surgical consultation | **Obtain emergent surgical consultation | ||
==Disposition== | ==Disposition== | ||
*Refer all patients for colonoscopy and | *Discharge | ||
*Refer all patients for colonoscopy and surgeon for consideration of repair | |||
==See Also== | ==See Also== | ||
*[[Anorectal | *[[Anorectal disorders]] | ||
==References== | ==References== | ||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
Latest revision as of 21:49, 7 July 2021
Background
- Circumferential protrusion of part or all layers of the rectum through the anal canal
- Complications are rare and include bleeding and ulceration
Risk factors
- Extremes of age
- Chronic constipation
Clinical Features
Most frequent complaint at the time of clinical presentation:[1]
- Sensation of a protruding rectal mass (98.7%)
- Painful defecation (36%)
- Fecal incontinence (38.7%)
- Rectal bleeding (25.3%)
- Constipation (25.3%)
- Rectal ulcer (8%)
- Patients may mistake prolapsed mucosa for hemorrhoids
Differential Diagnosis
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Coccydynia
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Fecal impaction
- Hemorrhoids
- Levator ani syndrome
- Pedunculated polyp
- Pilonidal cyst
- Proctalgia fugax
- Proctitis
- Pruritus ani
- Enterobius (pinworms)
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Non-GI Look-a-Likes
Evaluation
- Clinical diagnosis
Types
- Prolapse involving the rectal mucosa only
- Rarely protrudes more than 2 to 3 cm beyond the anal verge
- Anal edges appear everted
- Radially directed folds
- No sulcus between extruded mucosa and anus
- Frequently associated with 3rd and 4th degree hemorrhoids
- Prolapse involving all layers of the rectum
- May protrude up to 15 cm
- Anus appears normal
- Prolapse appears as red, ball-like mass with concentric folds
- Sulcus may be palpated between the extruded bowel and anus
- Intussusception of upper rectum into and through the lower rectum
Management
Children
- Reduce via slow steady pressure applied to prolapsed segment
- Prevent constipation
- Refer for evaluation of underlying condition (CF, pelvic floor weakness, diarrhea)
Adults
- Reduction
- Thumbs over luminal surfaces medially and fingers grasp outer walls laterally
- Apply continuous pressure first with thumbs followed by internal rolling of fingers
- After reduction perform digital rectal exam to evaluate for rectal mass/polyp
- Thumbs over luminal surfaces medially and fingers grasp outer walls laterally
- Difficult reduction
- Prolonged prolapse may lead to rectal wall edema
- Adequate sedation and analgesia is key to successful reduction
- Can incorporate a perianal block in certain cases
- Can place granulated sugar (not synthetic sweeteners) over prolapsed rectum
- Wait 15 min for edema to subside and re-attempt
- Failed reduction
- Obtain emergent surgical consultation
Disposition
- Discharge
- Refer all patients for colonoscopy and surgeon for consideration of repair
See Also
References
- ↑ Hammond K, et al. Rectal Prolapse: A 10-Year Experience. J. 2007 Spring; 7(1): 24–32. PMCID: PMC3096348