From the Guidelines
To perform a per rectal (PR) examination for a patient with rectal prolapse, first explain the procedure to the patient and obtain informed consent, then position the patient in the left lateral decubitus position with knees drawn up to their chest, wearing gloves and using adequate lubrication, as recommended by recent guidelines 1. When performing the PR examination, it is essential to begin with a visual inspection of the perianal area, noting any prolapsed rectal tissue, which appears as concentric rings of mucosa protruding from the anus.
- Ask the patient to bear down to better visualize the prolapse if it's not immediately evident.
- Gently insert a lubricated index finger into the rectum and assess for sphincter tone, which is often decreased in rectal prolapse patients, as noted in the American Gastroenterological Association medical position statement on constipation 1.
- Palpate the rectal walls for masses or irregularities, and note any tenderness.
- Evaluate the extent of the prolapse by determining if it's partial (mucosal) or complete (full-thickness). After examination, assist the patient in manually reducing the prolapse if present by applying gentle, steady pressure with a lubricated gloved hand.
- Document your findings thoroughly, including the size of prolapse, reducibility, and sphincter tone, as this examination helps distinguish rectal prolapse from hemorrhoids or other conditions and guides appropriate management decisions, according to the anorectal emergencies: WSES-AAST guidelines 1. It is crucial to prioritize the patient's comfort and safety during the examination, and to be aware of the potential complications of rectal prolapse, such as incarceration and strangulation, which require prompt surgical consultation and treatment, as emphasized in the guidelines 1.
From the Research
Diagnosis of Rectal Prolapse
To perform a physical exam for a patient with rectal prolapse, the following steps can be taken:
- A thorough medical history should be obtained to identify symptoms such as pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipation 2.
- A physical examination should be conducted to assess for a circumferential, full-thickness protrusion of the rectum through the anus 2.
- The patient's bowel habits, anatomy, and pre-operative expectations should be taken into consideration 2.
Preoperative Workup
The preoperative workup for a patient with rectal prolapse may include:
Surgical Management
Surgical management of rectal prolapse is aimed at restoring physiology by correcting the prolapse and improving continence and constipation 5. The optimum procedure is varied dependent upon patient characteristics 6.
Additional Considerations
It is essential to understand that rectal prolapse frequently coexists with other pelvic floor disorders, and patients may have symptoms associated with combined rectal and genital prolapse 5. In such cases, an interdisciplinary surgical approach may be required 5.