diagnosis

Last reviewed 01/2018

diagnosis

Rectal prolapse is a clinical diagnosis based on patient's history and supported by physical examination findings (1).

A detailed history of patients should be obtained

  • inquire about symptoms related to the condition including fecal incontinence versus constipation/obstructed defecation symptoms as well as stool consistency
  • should include a history to detect medical conditions that might influence management choice or surgery eligibility.
  • accurate drug history to identify any drugs may cause or exacerbate constipation and straining at stool and, thus, contribute to prolapse e.g. - opioids, anticholinergics, tricyclic antidepressants, antipsychotics, calcium channel blockers, iron
  • anorexia, weight loss, persistent abdominal pain, and distension with constipation or diarrhoea to rule out cancer or colitis (1,2)

Physical examination

  • abdominal
    • look for any signs of obstruction (eg, distention, visible peristalsis, increasing borborygmi), neoplasm (eg, palpable mass) or inflammation (eg, guarding, tenderness, mass)

  • perianal
    • in patients with a history suggesting rectal prolapse,  but not detected on physical examination, the prolapse may be easily reproducible when the patient strains while in the lateral or jack-knifed position or in the sitting or squatting position
    • aim is to differentiate  full-thickness rectal prolapse from mucosal prolapse or prolapsed haemorrhoids
      • mucosal prolapse - is thin and often segmental (not extending circumferentially around the anus)
      • full thickness prolapse - also may appear segmental, but more often it is circumferential and plum coloured, with concentric mucosal folds
      • prolapsed haemorrhoids, and mucosal rectal prolapse - typically have radial rather than concentric folds  

  • rectal examination
    • digital rectal examination helps in
      • identifying anal sphincter hypotonia
      • differentiating rectal prolapse from an intussusception with prolapse that originates from a higher level than the rectum.
        • majority of  rectal prolapse begins in the anorectal region, hence a digit passed up and around the sides of the prolapse encounters resistance.
        • intussusception originates more proximally, and the digit may be passed freely around the prolapsed segment without resistance (1,2)

Note:

  • rectal prolapse may also result as a complication of injury during a forceps delivery

Reference: