Rectal Prolapse and Procidentia

Prolapse of the rectum is a condition in which one or more layers of the rectum or anal canal protrudes through the anal orifice ( Fig. 103.1 ). It can be partial or complete. Partial prolapse involves only the mucosa, which usually extends no more than to 1 inch (2.5 cm) outside the anal canal. Procidentia is total prolapse, involving all the layers of the rectum. The mass is larger and bulbous, and it may eventually contain a hernial sac of peritoneum with a segment of bowel in the interior. Rectal prolapse is uncommon in children, but it may occur during infancy. Although usually idiopathic, it may be associated with congenital defects. Prolapse occurs with defecation, usually reduces spontaneously with conservative treatment, and is self-limited.

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Rectal Prolapse and Procidentia.

Rectal prolapse in adults occurs more often in women than in men. It is associated with poor pelvic musculature tone, chronic straining, fecal incontinence, and often neurologic or traumatic damage associated with the pelvis. Its etiology remains unknown, but a defect in the supporting structures may permit increased intraabdominal pressure to produce the prolapse. In elderly or debilitated persons, prolapse is usually caused by a loss of sphincteric tone.