Rectal Prolapse

A 75-year-old woman had a 1-year history of an anal protrusion, bloodstained mucus discharge, and anal incontinence of flatus and loose stools. The full-thickness rectal prolapse is seen here with the patient in the prone position. Anal sphincter tone was diminished. Sigmoidoscopy and barium enema studies revealed no intrinsic disease. Dr Virendra Parikh of Fort Wayne, Ind, writes that several factors can contribute to the development of rectal prolapse:

• A long-standing habit of straining during bowel movements.
• Stresses sustained during childbirth.
• Aging-related weakening of the ligaments that support the rectum inside the pelvis.
• Neurologic problems, such as spinal cord injury or disease.

A small number of patients with early rectal prolapse can be treated with a high-fiber diet and sitz baths. However, the condition usually requires surgical repair; perianal or abdominal procedures can be done. A perianal repair was performed in this patient.