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Investigations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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.

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