- Rectal Prolapse
- Protrusion of all or some layers of the Rectum via the anus with straining
- Intussception of the bowel through the anus
- Bimodal distribution: Pediatric and Elderly patients
- Full thickness Rectal Prolapse
- Internal prolapse (Internal Intussusception
- Prolapse not visible outside the anal canal
- Mucosal prolapse
- Progression of Hemorrhoids more than a pelvic support disorder
-
Chronic Constipation
- Conditions predisposing to straining at stool (e.g. Multiple pregnancies)
- Increasing Age (esp. women)
- Mass protruding from the anus
- Onset often after straining to stool
- Associated symptoms
- Rectal Pain
- Anal Discharge
- Rectal Bleeding
-
Incarcerated Hernia (rare)
- Tissue breakdown and necrosis of incarcerated bowel
- Management
-
Manual Reduction
- Contraindications
- Tissue necrosis
- Adjuncts
- Applying granulated sugar to rectal mucosa reduces local edema
- Anxiolysis (e.g. Midazolam)
- Analgesia (e.g. Fentanyl)
- Technique
- Avoid delays due to risks of prolonged prolapse with tissue breakdown and necrosis risk
- Patient lies in lateral decubitus position or prone position
- Apply granulated sugar or gauze soaked in sugar water over prolapsed mucosa for 10 to 20 minutes
- Assistant retracts the buttock cheeks
- Examiner applies both thumbs against the central opening, and other fingers resting against the buttocks
- Thumbs apply constant gentle pressure
- Fingers apply circumferential pressure, rotating the hands clockwise and counterclockwise
- Maintain over several minutes as the prolapse reduces
- Apply a pressure dressing against the anus to prevent a short-term recurrence
- First layer against the anus may be Vaseline Gauze
- Management
-
Other Measures
- Surgery Indications
- Failed reduction
- Incarcerated Hernia
- Disposition
- Follow-up for evaluation for malignancy (nidus for prolapse)
-
Pelvic Floor Exercises
- Avoid straining at stool
- Follow bowel regimen to maintain soft stools
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