Rectal prolapse is a relatively uncommon condition with an incidence of 2. True rectal prolapse involves the full thickness intussusception of the rectum through the anal canal such that the rectum is externalized. Other subtypes of rectal prolapse include internal prolapse, where intussusception occurs only within the anal canal and therefore, the rectum is not seen externally, and partial thickness prolapse where redundant mucosa prolapses.
Prolapse can occur intermittently; for some patients, prolapse occurs only with defecation while for others prolapse also occurs with standing or walking. The prevalence of rectal prolapse rises in two distinct patient populations: elderly women and younger women, particularly those with a history of chronic straining, functional bowel disorders, autism or other psychiatric disorders 3.
In this population, irritable bowel disorders, chronic straining conditions, connective tissue disorders and hypermobility e. Rectal prolapse is a bothersome disorder and can be debilitating for some patients. Commonly reported symptoms include FI, rectal urgency, pain, mucous discharge, constipation, and obstructed defecation difficult evacuation, incomplete evacuation, or need for digitation.
There are several validated questionnaires that can assist with a systematic assessment of bowel and pelvic floor symptoms 6 - 9. The prevalence of certain symptoms is variable with age. Older women with rectal prolapse are more likely to report pain and FI, while younger women are more likely to report obstructive defecation symptoms and prolapse only with defecation Initial evaluation for rectal prolapse includes a detailed history and inventory of all associated symptoms and risk factors.
Identification of the most bothersome symptom s to the patient is imperative as this can guide operative planning and facilitates expectation setting for post-operative outcomes. Additionally, evaluation for coexisting anterior and middle compartment prolapse is necessary, as patients with clinical signs suggestive of multiorgan prolapse should be referred for multidisciplinary evaluation 11 - On a physical exam, prolapse may or may not be readily obvious or easily reproduced.
