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Clinical features

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The patient complains of a variable length of 'something' coming down their back passage

  • initially occurs during defecation or while straining but reduces spontaneously
  • with time the condition becomes chronic and needs manual reduction
  • the patient may find it impossible to get outside the house and may become socially isolated.
  • often associated with mucous drainage and bleeding (1,2)

Patients often complain of a persisting dull perianal pain.

  • in cases of strangulation, there is severe pain associated with constitutional symptoms, such as fever, chills, diaphoresis, nausea, and vomiting (1,2).

One-half to three-fourths of patients with rectal prolapse will experience fecal incontinence with a predominant problem of control of flatus or stools. It can be

  • passive - manifests as leakage of which the patient is often initially unaware
  • urge - when a patient becomes aware of the need to open their bowels but cannot get to the toilet in time (1,2).

Up to two-thirds of patients may also complain about constipation. This is thought to be caused by bowel dysmotility and pelvic floor dyssynergia (1)

In addition

  • majority of patients also have urinary incontinence
  • multiple pelvic organ prolapse in females e.g. - uterovaginal prolapse or cystocele .

Reference:

  1. Jones OM, Cunningham C, Lindsey I. The assessment and management of rectal prolapse, rectal intussusception, rectocoele, and enterocoele in adults. BMJ. 2011;342:c7099.
  2. American Academy of Family physicians (AAFP). FP Comprehensive 2016 - Board Preparation. Anorectal conditions. Rectal prolapse

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