The walls of the rectum protrude through the opening of the anus and become visible

Aetiology

• Most common in the elderly but can occur in all ages, including children

Risk factors

• Increasing age
• Female gender
• Multiple deliveries
• Straining
• Previous traumatic vaginal delivery

Pathophysiology

• Partial thickness: rectal mucosa protrudes out of the anus
• Full thickness: rectal wall protrudes out the anus
  • Most common in elderly females

Clinical features

• Protruding mass from anus especially during defecation
• May reduce spontaneously
• Bleeding and passing mucus per rectum common
• Examination shows poor anal tone

Investigations

• Barium enema and/or colonoscopy: to evaluate the entire colon prior to surgery
• Other investigations to assess underlying conditions (as indicated) include stool microscopy and cultures for gastrointestinal infection and sweat test for cystic fibrosis