Rectal prolapse

Last revised by Dr Vikas Shah on 13 Aug 2020

Rectal prolapses refer to the prolapse of the rectum into the anal canal. They can involve the entire wall of the rectum or only the mucosal layer.

Rectal prolapse in Western populations is more common in females (M:F 1:4). In women, it is more common over the age of 50 years. In men, the incidence is relatively even over all age groups 1.

Patients may present with 1:

The exact cause of rectal prolapse is unknown and is likely multifactorial 2. Anatomical factors such as the diastasis of the levator ani muscle, a patulous anus or a redundant sigmoid colon are frequently found in rectal prolapse patients 1.

Prolapse may be classified as 2:

  • incomplete (internal): the rectum does not extrude through the anus
  • mucosal: only the mucosal layer is prolapsed
  • complete (external): the rectum extrudes through the anus

Diagnosis is often clinical if the prolapse can be seen on examination. Dynamic cystocolpoproctography can be used to confirm the diagnosis and can also reveal other associated defects or pelvic organ prolapse 3.

Surgery may be required in some cases with perineal and abdominal approaches existing 1Solitary rectal ulcer syndrome may be a complication of rectal prolapse 3.

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Cases and figures

  • Case 1: full thickness on fluoroscopy
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  • Case 2: full thickness on MRI
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  • Case 3: rectoanal mucosal intussusception on fluoroscopy
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  • Case 4: full thickness but not external on fluoroscopy
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  • Case 5: full thickness external rectal prolapse on fluoroscopy
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