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Rectal prolapse

Definition
  • Rectal prolapse: The protrusion of the rectal wall through the anal opening.
Types
  • Full-thickness prolapse: The entire wall of the rectum protrudes.
  • Mucosal prolapse: Only the mucosal layer protrudes.
Etiology
  • Chronic straining during defecation.
  • Chronic constipation or diarrhoea.
  • Pelvic floor dysfunction.
  • Prior pelvic surgeries.
  • Age-related changes in pelvic muscles and supporting structures.
Clinical Presentation
  • Visible protrusion from the anus, especially post-defecation.
  • Feeling of incomplete evacuation.
  • Mucus discharge or bleeding.
  • Fecal incontinence in some cases.
Investigations
  • Clinical examination: Inspection and digital rectal examination.
  • Proctosigmoidoscopy: To rule out other pathologies.
  • Anorectal manometry: To assess anal sphincter function.
Management
  • Conservative: Stool softeners, high-fibre diet, pelvic floor physiotherapy.
  • Surgical:
    • Abdominal procedures such as rectopexy.
    • Perineal procedures like Altemeier’s procedure (perineal rectosigmoidectomy).
Complications
  • Chronic ulceration or necrosis due to compromised blood supply.
  • Recurrence after surgical repair.
  • Strangulation (rare).
Prevention
  • Address underlying causes such as chronic constipation.
  • Regular pelvic floor exercises to strengthen supporting muscles.

Recognising rectal prolapse and differentiating it from other conditions like haemorrhoids is essential for accurate treatment and management.

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