How to Reduce Rectal Prolapse

• Indications:
  • Prolapse of rectum (full-thickness)
  • Mucosal prolapse of rectum (mucosa only)
• Contraindications:
  • Infarction or gangrene of prolapsed segment
  • Severe tenderness of prolapsed segment
  • Extreme edema of prolapsed segment
• Anesthesia:
  None

• Equipment:
  • Gloves
  • Water-soluble lubricant
• Positioning:
  Decubitus or dorsal lithotomy
• Technique:
  • Don gloves and apply a liberal amount of water-soluble lubricant to the prolapsed segment.
  • The concept is to apply steady, circumferential pressure on the prolapsed segment (to decrease edema) while simultaneously trying to reduce it. This is done by placing as many fingers of both hands as possible, oriented parallel to its longitudinal axis, around the segment and compressing it from all sides.
  • Apply pressure firmly and steadily, with more pressure applied at the tip than at the base.
  • Progress is typically slow and almost imperceptible. Be patient and squeeze for one to several minutes at a time, using plenty of lubricant.
  • To prevent recurrence, the patient should be placed on stool softeners and should be instructed in the technique of manual self-reduction of prolapsed hemorrhoids, which may occur at each bowel movement.
• Complications and Management:
  Unsuccessful reduction
  • May result in infarction of prolapsed segment
  • Requires surgical management with excision of prolapsed portion