Overview of rectal procidentia (rectal prolapse)
- Madhulika G Varma, MD
Madhulika G Varma, MD
- Associate Professor and Chief
- Section of Colorectal Surgery
- University of California, San Francisco
- Scott R Steele, MD, FACS, FASCRS
Scott R Steele, MD, FACS, FASCRS
- Professor of Surgery
- Case Western Reserve University
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 . 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.)
PELVIC FLOOR ANATOMY
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 . 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.
EPIDEMIOLOGY AND RISK FACTORS
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- Felt-Bersma RJ, Cuesta MA. Rectal prolapse, rectal intussusception, rectocele
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- Patel SM, Lembo AJ. Constipation: Rectal prolapse and solitary rectal ulcer syndrome. In: Sleisenger and Fordtan's Gastrointestinal and Liver Disease, 8th, Feldman M. (Ed), Saunders Elsevier, Philadelphia 2006. Vol 1, p.230.
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- Okamoto N, Maeda K, Kato R, et al. Dynamic pelvic three-dimensional computed tomography for investigation of pelvic abnormalities in patients with rectocele and rectal prolapse. J Gastroenterol 2006; 41:802.
- Hecht EM, Lee VS, Tanpitukpongse TP, et al. MRI of pelvic floor dysfunction: dynamic true fast imaging with steady-state precession versus HASTE. AJR Am J Roentgenol 2008; 191:352.
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- Steele SR, Varma MG, Prichard D, et al. The evolution of evaluation and management of urinary or fecal incontinence and pelvic organ prolapse. Curr Probl Surg 2015; 52:92.
- Steele SR, Varma MG, Prichard D, et al. The evolution of evaluation and management of urinary or fecal incontinence and pelvic organ prolapse. Curr Probl Surg 2015; 52:17.
- Kaufman HS, Buller JL, Thompson JR, et al. Dynamic pelvic magnetic resonance imaging and cystocolpoproctography alter surgical management of pelvic floor disorders. Dis Colon Rectum 2001; 44:1575.
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- Glasgow SC, Birnbaum EH, Kodner IJ, et al. Preoperative anal manometry predicts continence after perineal proctectomy for rectal prolapse. Dis Colon Rectum 2006; 49:1052.
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- Woods R, Voyvodic F, Schloithe AC, et al. Anal sphincter tears in patients with rectal prolapse and faecal incontinence. Colorectal Dis 2003; 5:544.
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- PELVIC FLOOR ANATOMY
- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL FEATURES
- Patient presentation
- Physical examination
- DIFFERENTIAL DIAGNOSIS
- POSTDIAGNOSTIC EVALUATIONS
- Radiographic studies
- Pelvic physiology studies
- Colonic transit study
- MEDICAL MANAGEMENT
- INDICATIONS FOR SURGICAL MANAGEMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS