Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of Grade III rectal prolapse, reporting a sensation of incomplete evacuation, tenesmus, and the need for manual splinting or digital pressure to facilitate defecation. History significant for internal intussusception, with intermittent protrusion of the rectal mucosa through the anal canal during straining. No reported history of fecal incontinence or rectal bleeding.
Clinical Examination Findings
Digital rectal examination (DRE) reveals redundant rectal mucosa with evidence of internal intussusception. Anoscopy confirms circumferential mucosal prolapse extending into the anal canal. No evidence of malignancy or ulceration. Anal sphincter tone is within normal limits; however, there is a palpable "telescoping" effect during simulated straining (Valsalva maneuver).
Treatment Protocol
Initial management includes high-fiber diet, adequate hydration, and avoidance of prolonged straining. Pelvic floor physical therapy (biofeedback) is recommended to improve evacuation mechanics. Surgical consultation for potential rectopexy (ventral or laparoscopic) is advised given the Grade III classification and symptomatic internal intussusception.