How to Diagnose Rectal Prolapse

Rectal prolapse is a protrusion of the rectal mucous membrane through the anus. It is most common in children under 4 years but is rare in industrialized countries due to improved nutrition and hygiene. Rectal prolapse should be considered a symptom and not a disease. Your primary goal upon diagnosis of this condition should be to determine its underlying cause. Here's how.

Instructions

1. Obtain the patient history. The most common cause of rectal prolapse is excessive straining from constipation. Other causes include prolonged sitting on the toilet or surgery to correct an imperforate anus.

2. Inquire about specific conditions associated with rectal prolapse. These include a congenitally enlarged colon, cystic fibrosis, Ehlers-Danlos syndrome, Hirschsprung disease, parasitic infections, pneumonia, polyps and rectal tumors.

3. Conduct a physical examination with the patient in a squatting position to check for a recurrence. Most rectal prolapses resolve before medical treatment is sought, so the patient is usually asymptomatic.

4. Differentiate a rectal prolapse from a prolapse of an intussusception. A rectal prolapse is plum colored and does not extend completely around the anus. An intussusception presents as a red mass which allows a finger to be passed between the anal wall and protruding mass.

5. Use laboratory studies to check for causes of rectal prolapse. Cystic fibrosis should always be suspected first as 11 to 23 percent of these patients have rectal prolapse. This condition is also associated with infections of Giardia, Entamoeba histolytica, Escherichia coli 0157:H7, Salmonella, Shigella and Trichuris.