Rectal prolapse

Incidence
Age
Sex
Geography
Aetiology	Partial prolapse - involves mucosa alone; prolapse rarely more than a few centimetres Complete prolapse - involves all layers of rectal wall and is most common in elderly females
Presentation	History - protruding mass from anus especially during defaecation - may reduce spontaneously; may need manual reduction and eventually become difficult to reduce - blood and mucus PR from ulceration of exposed mucosa Signs - mucosal prolapse - two layers of mucosa about 2-4 cm long with radial folds; lax sphincter on PR - complete prolapse - thick, up to 12 com long, patient may be unable to contract sphincter muscles after prolapse is reduced Differential diagnosis - prolapsing haemorrhoids - polyps - intusussception
Investigations
Macro
Micro
Staging
Serum Markers
Management	Mucosal prolapse - sclerosant injected submucosally - excision of prolapsed mucosa may be necessary Complete prolapse - abdominal rectopexy
Prognosis
Complications	- abdominal rectopexy may lead to residual incontinence due to chronic stretching of sphincter