RECTAL PROLAPSE

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

13. FOLLOW-UP