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Rectal prolapse

Rectal prolapse occurs when the rectum falls down and comes through the anal opening.

Causes, incidence, and risk factors

Rectal prolapse occurs most often in children under age 6 and in the elderly.

In children, it can be found with cystic fibrosis and whipworm (trichuriasis).

In adults, it is usually found with constipation. It is also more common in people with autism, psychiatric disorders, and intellectual disability.

Symptoms

The main symptom is a reddish-colored mass that sticks out from the opening of the anus, especially following a bowel movement. This reddish mass is actually the inner lining of the rectum. It may bleed slightly and can be uncomfortable and painful.

Signs and tests

The health care provider will perform a physical exam, which may include a rectal exam . Tests can determine the underlying cause.

Treatment

Call your health care provider if a rectal prolapse occurs. In some cases, the prolapse can be treated at home.

The rectum must be pushed back inside manually. A soft, warm, wet cloth is used to apply gentle pressure to the mass to push it back through the anal opening. The affected person should be lying down on his or her side in a knee-chest position before applying pressure to allow gravity to help return the prolapse.

Immediate surgery for repair is seldom needed. In children, treating the underlying condition usually solves the problem. In adults, the only cure for rectal prolapse is an operation.

Expectations (prognosis)

In children, treating the underlying condition usually cures the problem. In adults, surgery is usually successful at curing the prolapse.

Constipation and loss of bowel control may also develop.

Calling your health care provider

Call your health care provider promptly if there is a rectal prolapse.

Prevention

In children, treating the underlying condition usually prevents further rectal prolapse. Treating vascular constipation is an important preventive measure.

References

Lembo AJ, Ullman SP. Constipation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisinger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saudners Elsevier;2010:chap 18.

Fry RD, Mahmoud N, Maron DJ, Ross HM, Bleir JIS. Colon and rectum. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 52.

Verma M, Rafferty J, Buie WD. Practice parameters for the management of rectal prolapse. Dis Colon Rectum. 2011;54:1339-1346.

Updated: 8/17/2012

Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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