1. CHIEF COMPLAINT •Rectal prolapse 2. HPI 3. ROS 4. SYMPTOMS •Mass protruding through the anus •Pain •Fecal incontinence 5. HISTORY •FAMILY HISTORY •SOCIAL HISTORY •PASTMEDICAL HISTORY o Long-standing constipation o Pregnancy •SURGICAL HISTORY •CHRONIC CONDITIONS 6. ALLERGIES 7. PHYSICAL EXAMINATION 8. SPECIFIC DATA LIKE GRADING ETC •Partial: prolapse of rectal mucosa only •Complete: prolapse with all layers •Grade 1: occult prolapse •Grade 2: prolapse to but not through anus •Grade 3: any protrusion through anus 9. TESTS TO BE ORDERED •CBP •Barium enema •Video defecography •Anal rectal manometry •Sitz marker study •Rigid proctosigmoidoscopy

10.ASSESSMENT /PLAN Surgical care •Anterior resection •Marlex rectopexy •Suture rectopexy •Resection rectopexy •Perineal procedures •Anal encirclement •Delorme mucosal sleeve resection •Altemeier perineal rectosigmoidectomy •Hemorrhoidectomy 11.EDUCATION •Add fiber to your diet. You can increase your fiber intake by eating more fruits, vegetables, nuts and whole grains. The recommended amount of fiber is 20 to 35 grams of fiber daily. Most people don't get that much, so you may want to take a fiber supplement. Bulk-forming laxatives, such as psyllium (Fiberall, Metamucil, others), soften stools and allow them to pass more easily. Adding fiber through either diet or supplementation may cause gas and bloating, so increase your fiber intake gradually. •Drink adequate fluids. Fluids also help prevent constipation, so it's important to get enough. However, it may be difficult to determine how much is enough for you. If you're rarely thirsty and your urine looks colorless or very light yellow, you're probably drinking enough. •Exercise regularly. You can experience a host of benefits by walking or engaging in 30 minutes of another moderate activity most days of the week. Among those benefits are promoting regular bowel movements and increasing blood flow to all parts of your body, which may promote healing of an anal fissure. •Take a bath or a sitz bath. Soaking in warm water for 10 to 20 minutes one or more times a day, especially after bowel movements, will help ease pain and itching. Don't use soap or bubble bath, as this may irritate the area. Also, avoid using medicated or perfumed wipes because these also may irritate the area. •Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. 12.MEDICATION •Sodium docusate

•Calcium docusate •Psyllium •Methylcellulose

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