Rectal Prolapse
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Basics
Circumferential protrusion of the rectum beyond the anus
Description
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
Epidemiology
Incidence
- 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
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
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Circumferential protrusion of the rectum beyond the anus
Description
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
Epidemiology
Incidence
- 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
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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