Procidentia

My Butt Hurts (Procidentia)

Case: 79 year old female with abdominal pain

Definition	Full-thickness intussusception of the rectum through the anus
Epidemiology	Bimodal age distribution (extreme of age)
Causes	Children <3 increased abdominal pressure (constipation, chronic diarrhea) – Malnutrition, parasitic infection, or cystic fibrosis – Usually mucosal prolapse Adult weak pelvic floor (elderly female, multiparty) – Cancer 4 folds than general population – Usually full thickness
S & S	– Mass after defecation – Incontinence (75%) – Spotting, mucus – Concentric rectal rings
Treatment	Children usually conservative (treat the cause) Adult usually surgical In ED: – Reduced with normal rectal exam -> Rx symptomatic with surgery follow up – Not reduced, try sugar with gentle pressure. If reduced discharge, if not surgery consult.
Complication	Ulceration Incarceration Strangulation Perforation (can happen during reduction) Functional