Rectal prolapse: Difference between revisions
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Revision as of 03:31, 8 July 2016
Background
- Circumferential protrusion of part or all layers of the rectum through the anal canal
Risk factors
- Extremes of age
- Chronic constipation
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 w/ 3rd and 4th degree hemorrhoids
- Prolapse involving all layers of the rectum
- May protrude up to 15cm
- Anus appears normal
- Prolapse appears as red, ball-like mass w/ concentric folds
- Sulcus may be palpated between the extruded bowel and anus
- Intussusception of upper rectum into and through the lower rectum
Clinical Features
- Irritation to mucosa caused by recurrent prolapse results in mucous discharge and bleeding
- Anal sphincter weakness may result in fecal incontinence
- In children, parents often 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
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 place granulated sugar (not synthetic sweeteners) over prolapsed rectum
- Wait 15min for edema to subside and re-attempt
- Failed reduction
- Obtain emergent surgical consultation
Disposition
- Refer all patients for colonoscopy and to a surgeon for consideration of repair
Complications
- Rare, but include bleeding and ulceration
See Also
References
- Tintinalli
- Roberts