Rectal Prolapse

Description

• Full-thickness evagination of the rectal wall outside the anal opening
• 3 types of rectal prolapse:
  • Full-thickness prolapse:
    • Protrusion of the rectal wall through the anal canal; the most common
  • Partial thickness or mucosal prolapse:
    • Only mucosal layer protrudes through anus
  • Occult (internal) prolapse or rectal intussusception:
    • Rectal wall prolapse without protrusion through the anus
    • May be difficult to diagnose

Etiology

• Cause unclear and multifactorial:
  • Chronic constipation/excessive straining
  • Laxity of sphincter:
    • Pelvic floor trauma/weakness; childbearing
    • Neurologic disease
• More common in women, peak in seventh decade

• Very rare after age 4 yr
• True rectal prolapse unusual in children; more likely partial or intussusception
• Consider chronic diarrhea, parasites, cystic fibrosis (CF), malnutrition as contributing causes