A rectal prolapse is a form of pelvic organ prolapse and refers to the prolapse of the rectum into the anal canal. They can involve the entire wall of the rectum or only the mucosal layer.
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Epidemiology
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.
Clinical presentation
Patients may present with 1:
prolapsing of the rectum through the anus
fecal incontinence
constipation
Pathology
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
Radiographic features
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.
Treatment and prognosis
Surgery may be required in some cases with perineal and abdominal approaches existing 1. Solitary rectal ulcer syndrome may be a complication of rectal prolapse 3.