Most Common Symptom Associated with Complete Rectal Prolapse
The correct answer is C: Fecal incontinence is the most common associated complaint with complete rectal prolapse, as the prolapsing rectum stretches the anal sphincters leading to incontinence in the majority of patients.
Clinical Presentation Pattern
The symptom profile of complete rectal prolapse follows a characteristic hierarchy:
Fecal incontinence is the predominant symptom because the full-thickness circumferential protrusion of the rectum through the anus mechanically stretches and damages the anal sphincters over time 1. This sphincter dysfunction affects the majority of patients with complete rectal prolapse 2, 3.
Mucous discharge occurs frequently as a secondary symptom, resulting from the prolapsed rectal mucosa secreting mucus and causing soiling 2, 3, 4. However, this is less common than incontinence itself.
Bleeding (hematochezia) is reported in patients presenting to emergency departments with rectal prolapse 1, but it is not the primary complaint in most cases 2.
Pain is notably uncommon in uncomplicated rectal prolapse 1. Pain typically only occurs when the prolapse becomes incarcerated or strangulated, which are rare complications requiring emergency surgical intervention 1.
Supporting Evidence from Multiple Guidelines
The World Journal of Emergency Surgery guidelines specifically note that patients with rectal prolapse "usually complain of lower abdominal pain, constipation, and hematochezia" when presenting acutely 1, but the chronic presentation is dominated by incontinence. The American Gastroenterological Association emphasizes that rectal prolapse "tends to stretch the anal sphincters and cause incontinence" as its primary mechanism of morbidity 3.
Clinical Pitfall to Avoid
Do not confuse the presenting complaint (what brings the patient to medical attention, often the visible prolapsed mass) with the most common associated symptom (fecal incontinence, which causes the greatest impact on quality of life) 2, 5. While patients may initially seek care because they notice the prolapsing tissue, careful history-taking reveals that fecal incontinence is nearly universal and represents the most debilitating aspect of the condition 6, 2, 3.