Rectal Prolapse


Circumferential protrusion of the rectum beyond the anus


Several types

  • Partial prolapse
    • Involves only mucosa
    • Frequently follows operative anal procedures (radial rectal folds prolapsed through anus)
  • Complete prolapse
    • Involves the entire rectal wall (procidentia)
    • Due to pelvic floor weakness, neuropathy, colonic motility disorder
  • Grades
    • Grade 1: occult prolapse (internal rectal prolapse or rectal intussusception)
    • Grade 2: prolapse but not through anus
    • Grade 3: protrusion beyond anus



  • Predominant age: <3 years in children, 5th decade in adults
  • Predominant sex: female aged 50 years > male in adults; 80–90% of adult patients are female; male = female in children
  • 4/1,000 overall; 10/1,000 >65 years of age
  • Peak age in 7th decade

Geriatric Considerations
Common problem in the elderly

Pediatric Considerations
Idiopathic type is most common in children.

Etiology and Pathophysiology

The anatomic basis for prolapse is a weak pelvic floor.

  • Contributing factors in children:
    • Idiopathic (most common)
    • Abnormal innervation of levator ani complex, puborectalis, anal sphincter, or abnormal anatomic relation of these muscles
  • Contributing factors in adults:
    • Diastasis of levator ani
    • Loose endopelvic fascia
    • Sacral nerve root damage (diabetes, neoplasm)
    • Weak anal sphincter (internal or external)
    • Abnormally deep pouch of Douglas
    • Lack of normal mesorectum
    • Lateral ligament weakness
    • Pudendal neuropathy
    • Redundant sigmoid colon
    • Loss of rectal–sacral attachments
    • Chronic constipation and colonic dysmotility (1)[A]

General Prevention

Avoid constipation and diarrhea.

Commonly Associated Conditions

  • Cystic fibrosis (CF)
  • Myelomeningocele
  • Chronic constipation (25–50%) or diarrhea
  • Imperforate anus
  • Nerve damage (stroke or diabetes)
  • Fecal incontinence (50–75%)
  • Vaginal vault or uterine prolapse (13–30%)
  • Intellectual disability
  • Marfan syndrome
  • Ehlers-Danlos disease
  • Urinary incontinence (found in 25–35% of patients with rectal prolapse)
  • Renal calculi (particularly bladder stones)
  • Nutritional disorders
  • Progressive systemic sclerosis
  • Chronic constipation or diarrhea

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