Rectal Prolapse Associated With Chronic Ketamine Misuse: A Report of Two Cases.

Chronic ketamine misuse is a well-recognized cause of ketamine-induced uropathy (KIU), characterized by severe lower urinary tract symptoms and markedly reduced bladder capacity. Its potential association with anorectal dysfunction remains poorly described. We report two young adults with KIU who developed progressive pelvic floor dysfunction and anorectal pathology ranging from pelvic floor dyssynergia and internal rectal intussusception to full-thickness rectal prolapse (RP). Both patients experienced severe urinary frequency, suprapubic pain, and chronic straining to void. One patient developed solitary rectal ulcer syndrome with Grade III internal rectal intussusception, while the other developed full-thickness RP requiring colorectal assessment. These two case reports suggest a possible association between chronic ketamine misuse, severe urinary tract dysfunction, and secondary pelvic floor strain with subsequent anorectal pathology. Clinicians managing KIU should be alerted to evolving anorectal symptoms, and recreational ketamine use should be considered in young adults presenting with RP.