Rectal prolapse
Rectal prolapse is descent of rectal tissue through or within the anal canal, ranging from internal intussusception to external full-thickness prolapse; it causes a proluding mass, mucus, bleeding, obstructed defaecation or faecal incontinence and needs urgent review if it is irreducible, dusky or heavily bleeding.
Definition
Rectal prolapse is descent of rectal tissue through or within the anal canal. External full-thickness prolapse contains the entire rectal wall, mucosal prolapse contains mucosa alone and internal rectal prolapse is an intussusception that does not emerge through the anus.
First principles
Identify which layer has prolapsed
External full-thickness prolapse contains the whole rectal wall and typically shows concentric folds. Mucosal prolapse contains mucosa alone, while prolapsing haemorrhoids usually appear as separate cushions or lobes. Internal rectal prolapse or intussusception telescopes inside the rectum without necessarily emerging from the anus. These are related but not interchangeable diagnoses, and the treatment plan depends on the anatomy and symptoms.
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