Rectal prolapse occurs when full-thickness intussusception of the rectal wall protrudes externally through the anus. There is a spectrum of anatomic abnormalities associated with rectal prolapse, including diastasis of the levator ani, an abnormally deep cul-de-sac, a redundant sigmoid colon, a patulous anal sphincter, and loss or attenuation of the rectal sacral attachments. This benign condition can be debilitating for patients from the discomfort of the prolapsing tissue both internally and externally, mucus drainage and blood, and the common concomitant symptoms of fecal incontinence and constipation. In rectal prolapse patients, anterior compartment and pelvic organ prolapse symptoms, such as urinary incontinence and vaginal/uterine prolapse, are also common. Pelvic organ prolapse (POP) is a pelvic floor disorder in which the vaginal walls lose the ability to support the surrounding organs1. Up to a third of rectal prolapse patients report urinary incontinence, and 15- 30% have significant pelvic organ prolapse2, 3, 4.

The diagnosis of rectal prolapse is made primarily on history and physical examination. Thus, pelvic organ and rectal prolapse require a systematic history, targeted review of symptoms, and comprehensive physical exam. A multidisciplinary approach to treatment is recommended when there is significant symptomatic multicompartment prolapse. However, patients can initially present to many different types of providers and we all should be prepared to assess the symptoms and exam findings that we feel comfortable with and to refer when needed. There is a full consort of physical examinations every patient with pelvic organ or rectal prolapse should undergo. While every surgeon is not expected to perform every test, they should be able to perform a broad baseline assessment, then refer to colleagues when needed to ensure a complete evaluation is done. When the baseline assessment is done appropriately, enough information should be elicited to fully evaluate multi compartment prolapse, provide at least initial conservative treatments, and appropriate referrals to colleagues. Collaboration across specialties is ideal to ensure a comprehensive and complete evaluation is performed.

Here, a comprehensive examination for approaching the pelvic floor exam for prolapse is presented.. Goals in the initial exam for both specialties include ensuring critical pathology is not missed, improving cross specialty communication, decreasing unnecessary referrals, and preparing for joint interventions. As we describe our exam and findings, there is a need to use common terminology across specialties to ensure we are speaking the same language. To this end, the following are a list of standard terms5, 6, 7, 8, 9, 10 we will be using in this document (Table 1).