From the Guidelines
The workup for rectal prolapse should begin with a thorough history and physical examination, including digital rectal examination and assessment during straining, as well as laboratory tests such as complete blood count and serum creatinine to assess the status of the patient 1.
Initial Evaluation
The initial evaluation of a patient with suspected rectal prolapse should include:
- A thorough history to identify underlying medical conditions that may be contributing to the prolapse
- A physical examination, including digital rectal examination and assessment during straining, to confirm the diagnosis and assess the extent of the prolapse
- Laboratory tests, such as complete blood count, serum creatinine, and inflammatory markers (e.g., C-reactive protein, procalcitonin, and lactates) to assess the status of the patient and identify any potential complications 1
Diagnostic Tests
Additional diagnostic tests that may be useful in the evaluation of rectal prolapse include:
- Colonoscopy to rule out underlying colorectal pathology
- Defecography (either conventional or MRI) to confirm the diagnosis, assess the extent of the prolapse, and identify concurrent pelvic floor disorders
- Anorectal manometry to evaluate sphincter function and rectal sensation
- Endoanal ultrasound to detect sphincter defects
- Transit studies to evaluate constipation
Treatment Planning
The treatment plan for rectal prolapse should be individualized based on the patient's specific characteristics, including age, comorbidities, and concurrent pelvic floor disorders. Surgical intervention may be necessary for complete prolapse, with the specific surgical approach determined by patient factors and surgeon's skills and expertise 1. In patients with complicated rectal prolapse, non-operative management may be attempted, but surgical treatment should not be delayed if there are signs of ischemia or perforation 1.
From the Research
Rectal Prolapse Workup
The workup for rectal prolapse typically involves a combination of physical examination, diagnostic tests, and patient history to determine the best course of treatment.
- Physical exam: to assess the extent of the prolapse and identify any associated abnormalities 2, 3, 4
- Colonoscopy: to rule out any underlying conditions that may be contributing to the prolapse 2
- Anoscopy: to evaluate the anal canal and rectum for any abnormalities 2
- Defecography: to assess the function of the rectum and pelvic floor, and to identify any associated conditions such as rectocele or perineal descent syndrome 2, 3, 5
- Anal manometry: to assess the function of the anal sphincters and identify any abnormalities 2, 5
- Electrophysiologic testing: may be used in select cases to assess the function of the pelvic floor muscles 3
- Ultrasound: may be used in select cases to evaluate the anatomy of the rectum and pelvic floor 3
- Dynamic CT of the pelvis: may be used in select cases to evaluate the morphology of the rectum and identify any associated conditions 5
Diagnostic Considerations
The diagnosis of rectal prolapse is typically made based on physical examination, although several other modalities may be used to provide additional information about the patient's condition 4.
- Rectal prolapse can present in a variety of forms, including complete external rectal prolapse, rectal intussusception, and mucosal prolapse 2, 5
- Associated symptoms may include pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipation 2, 4
- The goal of treatment is not only to correct the prolapse, but also to improve function to the greatest extent possible 3