A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved.

Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may be mucous discharge (mucus coming from the anus), rectal bleeding, degrees of fecal incontinence, and obstructed defecation symptoms.) is

a full thickness, circumferential, true intussusception of the rectal wall which protrudes from the anus and is visible externally.

Internal rectal intussusception (occult rectal prolapse, internal procidentia) can be defined as a funnel shaped infolding of the upper rectal (or lower sigmoid) wall that can occur during defecation. This infolding is perhaps best visualised as folding a sock inside out, Another definition is "where the rectum collapses but does not exit the anus". Many sources differentiate between internal rectal intussusception and mucosal prolapse, implying that the former is a full thickness prolapse of rectal wall. However, a publication by the American Society of Colon and Rectal Surgeons stated that internal rectal intussusception involved the mucosal and submucosal layers separating from the underlying muscularis mucosa layer attachments, resulting in the separated portion of rectal lining "sliding" down. refers to prolapse of the loosening of the submucosal attachments to the muscularis propria of the distal rectummucosal layer of the rectal wall. Most sources define mucosal prolapse as an external, segmental prolapse which is easily confused with prolapsed (3rd or 4th degree) hemorrhoids (piles). However, both internal mucosal prolapse (see below) and circumferential mucosal prolapse are described by some.

Internal mucosal prolapse (rectal internal mucosal prolapse, RIMP) refers to prolapse of the mucosal layer of the rectal wall which does not protrude externally. There is some controversy surrounding this condition as to its relationship with hemorrhoidal disease, or whether it is a separate entity. The term "mucosal hemorrhoidal prolapse" is also used.

Solitary rectal ulcer syndrome (SRUS, solitary rectal ulcer, SRU) occurs with internal rectal intussusception and is part of the spectrum of rectal prolapse conditions. It describes ulceration of the rectal lining caused by repeated frictional damage as the internal intussusception is forced into the anal canal during straining. SRUS can be considered a consequence of internal intussusception, which can be demonstrated in 94% of cases.

Mucosal prolapse syndrome (MPS) is recognized by some. It includes solitary rectal ulcer syndrome, rectal prolapse, proctitis cystica profunda, and inflammatory polyps. It is classified as a chronic benign inflammatory disorder.

Rectal prolapse and internal rectal intussusception has been classified according to the size of the prolapsed section of rectum, a function of rectal mobility from the sacrum and infolding of the rectum. This classification also takes into account sphincter relaxation:

  • Grade I: nonrelaxation of the sphincter mechanism (anismus)
  • Grade II: mild intussusception
  • Grade III: moderate intussusception
  • Grade IV: severe intussusception
  • Grade V: rectal prolapse

Rectal internal mucosal prolapse has been graded according to the level of descent of the intussusceptum, which was predictive of symptom severity:

  • first degree prolapse is detectable below the anorectal ring on straining
  • second degree when it reached the dentate line
  • third degree when it reached the anal verge

framed|right|A. Normal anatomy: (r) rectum, (a) anal canal <br /> B. Recto-rectal intussusception <br /> C. Recto-anal intussusception

The most widely used classification of internal rectal prolapse is according to the height on the rectal/sigmoid wall from which they originate and by whether the intussusceptum remains within the rectum or extends into the anal canal. The height of intussusception from the anal canal is usually estimated by defecography. It may occur at any age, even in children, but there is peak onset in the fourth and seventh decades. When males are affected, they tend to be young and report significant bowel function symptoms, especially obstructed defecation, Since rectal prolapse itself causes functional obstruction, more straining may result from a small prolapse, with increasing damage to the anatomy.

  • COPD
  • cystic fibrosis

The association with uterine prolapse (10–25%) and cystocele (35%) may suggest that there is some underlying abnormality of the pelvic floor that affects multiple pelvic organs. The factors that result in a patient progressing from internal intussusception to a full thickness rectal prolapse remain unknown.

Treatment

Conservative

Surgery is thought to be the only option to potentially cure a complete rectal prolapse. Abdominal approach (trans-abdominal approach) involves the surgeon cutting into the abdomen and gaining surgical access to the pelvic cavity. Procedures for rectal prolapse may involve fixation of the bowel (rectopexy), or resection (a portion removed), or both.

Abdominal procedures

The abdominal approach carries a small risk of impotence in males (e.g. 1–2% in abdominal rectopexy). The term internal rectal prolapse is used when the prolapsed section of rectal wall remains inside the body and is not visible outside the body.

It may not cause any symptoms, or may cause obstructed defecation syndrome The causes are not clear. It may represent the first stage of a progressive condition that eventually may result in external rectal prolapse, It is possible that chronic straining during defecation (dyssynergic defecation / anismus), connective tissue disorders, and anatomic factors (e.g. loose connection of rectum to the sacrum, redundant sigmoid, deep pouch of Douglas) are involved.

Diagnosis is by defecography. More severe forms of internal rectal prolapse are associated with older age. Symptoms are variable. There may be hematochezia (bleeding), obstructed defecation, or no symptoms at all. Very often but not always SRUS occurs in association with varying degrees of rectal prolapse. Treatment is by normalization of bowel habits,

Colitis cystica profunda

Another condition associated with internal intussusception is colitis cystica profunda (also known as CCP, or proctitis cystica profunda), which is cystica profunda in the rectum. Cystica profunda is characterized by formation of mucin cysts in the muscle layers of the gut lining, and it can occur anywhere along the gastrointestinal tract. When it occurs in the rectum, some believe to be an interchangeable diagnosis with SRUS since the histologic features of the conditions overlap. Indeed, CCP is managed identically to SRUS.

Mucosal prolapse syndrome

A group of conditions known as Mucosal prolapse syndrome (MPS) has now been recognized. It includes SRUS, rectal prolapse, proctitis cystica profunda, and inflammatory polyps. It affects women more commonly, with a female to male ratio of 9:1. The first written report is in the Ebers Papyrus (1500 BC). An Egyptian mummy from 400 to 500 BC was discovered to have rectal prolapse.

Society and culture

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Rosebud pornography and prolapse pornography (rosebudding / rectal prolapse pornography) is an anal sex practice that occurs in some extreme anal pornography, wherein a pornographic actor or actress deliberately performs a rectal prolapse. "Rosebudding" is an example of producers making extreme content due to the easy availability of free pornography on the internet. Rosebudding is a way for pornographic actors and actresses to distinguish themselves. Some who participate in this form of pornography may be unaware of the consequences. Procidentia usually refers to uterine prolapse, but rectal procidentia can also be a synonym for rectal prolapse.

Intussusception is defined as invagination (infolding), especially referring to "the slipping of a length of intestine into an adjacent portion". It is derived from the Latin intus - "within" and susceptio - "action of undertaking", from suscipere - "to take up". Rectal intussusception is not to be confused with other intussusceptions involving colon or small intestine, which can sometimes be a medical emergency. Rectal intussusception by contrast is not life-threatening.

Intussusceptum refers to the proximal section of rectal wall, which telescopes into the lumen of the distal section of rectum (termed the intussuscipiens).