What disorder of the anus or rectum is this likely to be?

Question

A 55-year-old retired property manager comes to your clinic, concerned that she may have a tumor in her rectum. When asked why, she states that after straining at a bowel movement she felt a mass around her rectum. She denies any blood in her stool, black stools, or pain with defecation. She admits to having had chronic constipation for 30 years. She often uses laxatives to be able to have a bowel movement. She denies any recent weight gain, weight loss, fever, or night sweats. Her past medical history consists of hypothyroidism, and she has had two spontaneous vaginal deliveries. Her mother died recently of colon cancer and her father has high blood pressure but is otherwise healthy. She denies any smoking and only occasionally drinks alcohol. On examination she seems nervous. Her blood pressure is 140/90 and her pulse is 100. Her cardiac, lung, and abdominal examinations are normal. On visualization of her anus, no inflammation, masses, or fissures are noted. When she is asked to bear down, you see a rosette of red mucosa prolapsing from the anus. On digital rectal examination there are no masses and no blood is found on the glove.

A) Prolapse of the rectum
B) Internal hemorrhoids
C) Anorectal cancer
D) Prostate cancer

Answer 1

A) Prolapse of the rectum

Unless someone is bearing down, such as during a bowel movement, the red mucosa is not seen. This is common when there is heavy straining during a bowel movement. This finding in a young child or infant may lead you to suspect cystic fibrosis.