Rectal prolapse: Difference between revisions
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*Painful defecation (36%) | *Painful defecation (36%) | ||
*Fecal incontinence (38.7%) | *Fecal incontinence (38.7%) | ||
*Rectal bleeding (25.3%) | *[[Rectal bleeding]] (25.3%) | ||
*Constipation (25.3%) | *[[Constipation]] (25.3%) | ||
*Rectal ulcer (8%) | *Rectal ulcer (8%) | ||
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*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 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 | ||
Revision as of 04:18, 24 September 2019
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
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
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
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