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Overview of rectal procidentia (rectal prolapse)

Madhulika G Varma, MD
Scott R Steele, MD, FACS, FASCRS
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


Rectal procidentia, also called rectal prolapse, is a pelvic floor disorder that typically occurs in elderly women, but can occur in men and women of all ages [1,2]. Rectal prolapse results in local symptoms (eg, pain, bleeding, and seepage), bowel dysfunction (eg, constipation, incontinence), and a diminished and disabled quality of life [3,4].

An occult rectal prolapse involves intussusception, a “telescoping” of the bowel on itself internally, without protruding through the anal verge and is not a true rectal prolapse [1]. An occult prolapse (ie, intussusception) does not always lead to full thickness rectal prolapse, although patients may experience similar symptoms (eg, obstructed defecation, seepage) [5-7]. (See 'Clinical features' below.)


The pelvic floor, also called the pelvic diaphragm, includes muscles (eg, levator ani, coccygeus) and fascia that support the pelvic organs of the lower abdominal cavity (eg, rectum, bladder, uterus) (figure 1 and figure 2). The pelvic floor separates the true pelvis from the perineum. The linked figures illustrate the pelvic anatomy for men (figure 3 and figure 4 and figure 5) and women (figure 6 and figure 7). The female pelvic anatomy is reviewed elsewhere. (See "Surgical female pelvic anatomy".)


A complete rectal prolapse is the protrusion of all layers of the rectum through the anus, manifesting as concentric rings of rectal mucosa (picture 1). No standard method of classification has been widely accepted [3]. Complete rectal procidentia is a circumferential full thickness rectal wall prolapse beyond the anal canal [8,9]. Partial procidentia involves prolapse of the mucosa only.


Rectal procidentia is uncommon, with an incidence between 0.25 to 0.42 percent in the adult population [2,10], and the prevalence is estimated at 1 percent in adults over age 65 years [3,10].


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Literature review current through: Sep 2016. | This topic last updated: Jun 3, 2015.
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