Rectal prolapse is when the full thickness of the rectal wall slides out through the anus. It is most common in older women and is linked to chronic straining, constipation, a weak pelvic floor and past childbirth.
Key symptoms
- A mass coming out of the anus with bowel movements or standing
- Mucus discharge and soiling
- Fecal incontinence
- Constipation or a feeling of incomplete emptying
- Bleeding from the exposed lining
What you find on exam
- Ask the patient to strain, ideally sitting on a toilet
- Concentric rings of mucosa (prolapse) versus radial folds (hemorrhoids)
- Anal sphincter tone on rectal exam
- Color change that suggests strangulation
Tests
- Mainly a clinical diagnosis
- Colonoscopy to rule out a mass leading the prolapse
- Defecography when the prolapse cannot be shown on exam
- Anorectal manometry in selected patients
Treatment basics
- Fiber, fluids and stool softeners to avoid straining
- Manual reduction of an acute prolapse; sugar can reduce swelling
- Surgery is the definitive fix: abdominal rectopexy or perineal repair
- Pelvic floor physical therapy for related problems
Red flags
- Prolapse that cannot be pushed back
- Dark, purple or black tissue (strangulation)
- Heavy bleeding or severe pain
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.