Rectal Prolapse

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Rectal prolapse, known as procidentia, is the circumferential protrusion of part or all layers of the rectum through the anal canal. There are three classes of rectal prolapse: (1) prolapse involving the rectal mucosa only, (2) prolapse involving all layers of the rectum, and (3) intussusception of the upper rectum into and through the lower rectum so that the apex of the intussusception protrudes through the anus.

In the first group, seen primarily in children under the age of 2, the prolapse occurs because of the loose attachment of the mucosa to the submucosal layers, and there is an associated weakness of the anal sphincter. In the second and third groups, prolapse occurs because of the laxity of the pelvic fascia and muscles in addition to a generalized weakening of the anal sphincters. In all cases, the rectum does not conform with, but lies anterior to the sacral concavity, thus obliterating the angulation that normally occurs between rectum and anus. The prolapsing mucosa of a partial prolapse rarely protrudes more than 4 cm beyond the anal verge; the mucosal folds emanate in a radial fashion from the central lumen of the prolapsed mucosa. Mucosal prolapse is frequently associated with third- and fourth-degree hemorrhoids (see T§b!§..Z8.-i).

Complete rectal prolapse (procidentia) occurs at the extremes of life, most commonly in elderly women. Multiparity is not a contributing factor to rectal prolapse; there appears to be a higher incidence of prolapse in women who have had a hysterectomy.

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