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Rectal Prolapse

Rectal Prolapse is a topic covered in the 5-Minute Clinical Consult.

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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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Stephens, Mark B., et al., editors. "Rectal Prolapse." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116513/all/Rectal_Prolapse.
Rectal Prolapse. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116513/all/Rectal_Prolapse. Accessed June 19, 2019.
Rectal Prolapse. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116513/all/Rectal_Prolapse
Rectal Prolapse [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 June 19]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116513/all/Rectal_Prolapse.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Rectal Prolapse ID - 116513 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116513/all/Rectal_Prolapse PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -