Document Detail

Rectal prolapse associated with bulimia nervosa: report of seven cases.
MedLine Citation:
PMID:  9369117     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Rectal prolapse is a condition in which, when complete, the full thickness of the rectal wall protrudes through the anus. Bulimia nervosa is an eating disorder characterized by periodic food binges, which are followed by purging. Purging usually takes the form of self-induced vomiting, laxative abuse, and/or diuretic abuse. We report seven cases of rectal prolapse associated with bulimia nervosa. METHODS: The case histories of seven women with rectal prolapse and bulimia nervosa, average age 29 (range 21-42) years, seen over a period of 11 years (1987-1997) were reviewed. An analysis of the clinical data, including history, presenting physical examination, surgical treatment, and outcome was performed. RESULTS: All seven patients had a diagnosis of bulimia nervosa, made either before or with a diagnosis of rectal prolapse. Rectal prolapse was confirmed in each patient at anorectal examination. Five patients underwent sigmoid resection with proctopexy, one died before operative therapy, and one awaits further treatment. One of the five surgical patients had a recurrence that was managed by a perineal rectosigmoidectomy. CONCLUSION: To our knowledge, despite extensive review of both bulimia nervosa and rectal prolapse as seen in the medical literature, an association between the two has not been described previously. Several aspects of bulimia nervosa, including constipation, laxative use, overzealous exercise, and increased intra-abdominal pressure from forced vomiting are likely causes for the probable relationship with rectal prolapse. The possibility that an atypically young female presenting with rectal prolapse may also have bulimia nervosa should be taken into account by clinicians. This may assist the diagnosis of bulimia nervosa, a disease with multiple morbidities. Conversely, a patient being treated for bulimia nervosa who develops anorectal symptoms may come to earlier diagnosis and treatment for rectal prolapse.
M Malik; J Stratton; W B Sweeney
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  40     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  1997 Nov 
Date Detail:
Created Date:  1997-12-03     Completed Date:  1997-12-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1382-5     Citation Subset:  IM    
Department of Surgery, University of Massachusetts Medical Center, Worcester 01655, USA.
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MeSH Terms
Age Factors
Bulimia / complications*
Cathartics / adverse effects
Gastrointestinal Hemorrhage / etiology
Rectal Prolapse / diagnosis,  etiology*,  physiopathology
Reg. No./Substance:

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