Clinical features

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