Rectal prolapse during pregnancy. A case report.

BACKGROUND

Rectal prolapse is a bothersome surgical problem that is relatively infrequent. It usually occurs in the fifth to seventh decades of life and is more common in women.

CASE: A 33-year-old woman, gravida 3, para 2, was found to have a large rectal prolapse at 33 weeks' gestation. Manual reduction was successfully performed after injecting 2% lidocaine into and around the anal sphincter. Because she could not undergo definitive surgical repair during her pregnancy, the patient was managed with an aggressive stool softening regimen and self-reduction techniques. Labor was induced in the 40th gestational week. Epidural anesthesia was employed, and delivery was accomplished via low-outlet forceps application. The patient underwent definitive surgical repair of the rectal prolapse eight weeks postpartum.

CONCLUSION

Rectal prolapse is a rare condition during the childbearing years. We found no prior case reports of rectal prolapse occurring during pregnancy. While childbirth itself is not considered a risk factor for rectal prolapse, a prior history of perineal lacerations may be a risk factor. To manage rectal prolapse that occurs during pregnancy, consideration should be given to passive forceps delivery under epidural anesthesia to avoid the possibility of worsening the prolapse.