Causes of Procidentia (Complete Rectal or Uterovaginal Prolapse)

Primary Etiologic Factors

Chronic straining from constipation or defecatory disorders contributes to progressive descent of pelvic organs through the pelvic floor hiatus 1

Fascial defects in anterior, posterior, and apical compartments permit simultaneous prolapse of multiple pelvic organs (bladder, uterus/vagina, rectum) 2
Rectal wall abnormalities, including full-thickness intussusception, can progress to external prolapse (procidentia) when the rectal wall protrudes beyond the anal verge 3

Colorectal malignancy may present initially as sudden rectal procidentia, with patients exhibiting a 4.2-fold increased relative risk for rectosigmoid cancer compared to age-matched controls (5.7% vs 1.4% prevalence) 2
Chronic constipation and mucosal irritation related to prolonged straining may increase cancer incidence in this population 2
Rectocele is an independent risk factor (OR=4.9) for developing fecal incontinence and associated prolapse 4, 5

Increased intra-abdominal pressure from obesity (higher BMI associated with OR=1.1 per unit increase), chronic cough, or heavy lifting accelerates pelvic floor descent 4, 5

The American College of Gastroenterology recommends that clinicians do not overlook colorectal cancer screening in patients presenting with procidentia, as endoscopic examination should be performed given the significantly elevated cancer risk, particularly in older patients with new-onset prolapse 2