What are the key clinical features to consider when diagnosing rectal prolapse in adults?

Key clinical features to consider when diagnosing rectal prolapse in adults include:

• Visible or palpable full-thickness protrusion of the rectal wall through the anus, often described as a circumferential, concentric mass that may be reducible or irreducible.
• Symptoms of a sensation of a mass or bulge from the anus, which may worsen with straining or defecation.
• Associated faecal incontinence or mucus discharge due to mucosal irritation and sphincter dysfunction.
• Chronic constipation or straining history, which can contribute to the development of prolapse.
• Possible bleeding or ulceration on the prolapsed segment, which may indicate complications such as solitary rectal ulcer syndrome.
• On examination, the prolapse may be elicited or observed during straining or coughing, and differentiation from other anorectal conditions such as rectocele or mucosal prolapse is important.

These features are supported by UK clinical guidelines on faecal incontinence and pelvic organ prolapse, which emphasize the importance of a thorough clinical history and physical examination to identify the characteristic protrusion and associated symptoms NICE CG49,NICE NG123. Recent literature further highlights the need to consider overlapping conditions such as solitary rectal ulcer syndrome, which can present with bleeding and ulceration on the prolapsed mucosa Zhu et al. 2014. Additionally, distinguishing rectal prolapse from rectocele is critical, as the latter may present with similar symptoms but requires different management Bharucha & Knowles 2022.