How is rectal prolapse identified in patients with constipation and when is a sigmoidoscopy indicated?

Updated: Mar 30, 2020
  • Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: BS Anand, MD  more...
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Rectal prolapse may be either external or internal. The anus should be carefully examined for prolapse at rest and during a Valsalva maneuver. Care should be taken to distinguish a true full-thickness rectal prolapse from a mucosal prolapse, which is unlikely to cause constipation. Asking the patient to perform a Valsalva with the examining finger in the rectum in order to seek evidence of an internal prolapse may be worthwhile, although this is a relatively insensitive way of diagnosing prolapse.

In contrast to inguinal hernias, rectal prolapse is typically related to constipation. At least one retrospective study has demonstrated a strong association between rectal prolapse and rectosigmoid neoplasms in patients older than 50 years. Sigmoidoscopy is probably indicated for these patients, and a full colonoscopy should be performed if they are otherwise due for colorectal cancer screening.

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