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Examining for rectal prolapse

Examining for rectal prolapse. Most NOT evident in lying position as rest Ask patient to bear down – most still not evident

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Examining for rectal prolapse

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  1. Examining for rectal prolapse • Most NOT evident in lying position as rest • Ask patient to bear down – most still not evident • Need to examine after straining on the toilet for 1-2 minutes – lean forward – observe from behind – estimate in centimetres - ? full thickness circumferential, or partial mucosal only?

  2. Ano-rectal digital examination • Resting tone (low = IAS problem) • Squeeze pressure (low = EAS problem) • Co-ordination • Pubo-rectalis (pelvic floor function) • Sensation (? Neurological dysfunction) • Assessment stops here for MOST patients

  3. Abdominal transit study • Patient takes 20 radio-opaque markers on 3 consecutive days • Attends for plain abdominal X-ray on day 6 • 80% of markers should have been passed • Can distinguish slow whole gut transit from rectal outlet delay

  4. Assessment • Most can be done by a nurse • Takes time (we allow 1 hour in my clinic) • Remember how embarrassed most patients will be • Many patients have more than one cause (especially older people) • If you find the cause, you often know how to treat

  5. Website: www.bowelcontrol.org.uk

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