Synopsis
Differentiate rectal prolapse from haemorrhoidal or pelvic-organ prolapse, assess faecal incontinence systematically, and progress from reversible causes to specialist functional treatment.
- Full-thickness rectal prolapse produces concentric circumferential folds; prolapsing haemorrhoids form discrete radial columns, while mucosal prolapse is a more limited lining descent.
- Symptoms include a protruding mass, mucus, bleeding, incomplete evacuation, obstructed defaecation, urgency and passive leakage; patients may need to photograph an intermittent prolapse.
- Faecal incontinence means involuntary loss of stool that is a social or hygienic problem and should be asked about directly and without stigma.
Key red flags
A swollen irreducible segment with escalating pain, bleeding, ulceration or dusky colour suggests venous obstruction and threatened ischaemia, requiring urgent specialist reduction or surgery.
Investigation priorities
Define stool form, timing, triggers, urgency, leakage and toileting context.
Management branches
Any involuntary stool loss that causes a social or hygienic problem.
- Ask sensitively about solid, liquid and flatus leakage, awareness, urgency, frequency, obstetric and surgical history, stool form, diet, medicines, cognition, mobility and toilet access.
- Treat immediate reversible causes including faecal loading, acute diarrhoea, infection and medication effects; investigate red flags and provide skin protection and practical containment meanwhile.
Key medicines
LoperamideStart low and titrate timing and amount under the continence plan.
Bulk-forming fibre preparationIntroduce gradually with adequate fluid and adjust against the stool diary.