Investigations

The following series of investigations may be of value for rectal prolapse:

• colonoscopy
  • to rule out the presence of a lead point (e.g., mass or other pathology) and to assure that there is no other colonic pathology
  • biopsy can be considered to rule out dysplasia and other pathologies
    • histopathology most commonly shows features of “solitary rectal ulcer syndrome”
• sigmoidoscopy:
  • this may show lavatory paper in the rectum that has been used to replace the prolapse
  • traumatic proctitis may be revealed
• proctoscopy:
  • the prolapse will be seen to fill the lumen
  • assess for any anal lesions
• evacuation proctography:
  • also called defecography, it is carried out by administering barium paste into the rectum and oral contrast followed by videofluoroscopy recording as the patient defecates
    • women may be asked to consent to insertion of contrast into the vagina to delineate its position
  • also a useful tool to aid in the diagnosis of patients with reported prolapse that cannot be reproduced on clinical exam
  • demonstrates an increased anorectal angle, occlusion of the rectal canal or recto-recto intussusception
  • may also reveal associated defects such as cystocele, vaginal vault prolapse, and enterocele
• anorectal manometry:
  • intraluminal pressures in the anus and rectum can be measured at different levels with the sphincters lax and also maximally contracted
  • the results are compared to normal controls (1,2,3)

Additional studies which can be carried out include:

• urodynamic studies
  • to identify the nature and extent of urinary incontinence and to choose a surgical procedure accordingly
• dynamic pelvic magnetic resonance imaging
• electromyography and/or pudendal nerve terminal motor latency (1,2,3)

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. Varma M et al.Practice parameters for the management of rectal prolapse. Dis Colon Rectum. 2011;54(11):1339-46
3. Bordeianou L et al. Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. J Gastrointest Surg. 2014;18(5):1059-69.