Examining for rectal prolapse• Most NOT evident in lying position as rest• Ask patient to bear down – most still not

evident• Need to examine after straining on the

toilet for 1-2 minutes – lean forward – observe from behind – estimate in centimetres - ? full thickness circumferential, or partial mucosal only?

Ano-rectal digital examination• Resting tone (low = IAS problem)

• Squeeze pressure (low = EAS problem)

• Co-ordination

• Pubo-rectalis (pelvic floor function)

• Sensation (? Neurological dysfunction)

• Assessment stops here for MOST patients

Abdominal transit study• Patient takes 20

radio-opaque markers on 3 consecutive days

• Attends for plain abdominal X-ray on day 6

• 80% of markers should have been passed

• Can distinguish slow whole gut transit from rectal outlet delay

Assessment

• Most can be done by a nurse

• Takes time (we allow 1 hour in my clinic)

• Remember how embarrassed most patients will be

• Many patients have more than one cause (especially older people)

• If you find the cause, you often know how to treat

Website: www.bowelcontrol.org.uk