In rectal prolapse, fluoroscopic defecography, MRI defecography, or balloon expulsion testing may be helpful for diagnosis. Pre-operatively, all patients should undergo anoscopy and colonoscopy.

If rectal prolapse is suspected but cannot be detected during physical examination, fluoroscopic defecography, MRI defecography or balloon expulsion testing (a 4-cm long balloon filled with warm water is placed in the rectum and asked the patient to expel the balloon. A stop watch is provided to assess the time required for expulsion) may be helpful for diagnosis.^[1][2]

Pre-operatively, all patients should undergo anoscopy to rule out prolapsed internal hemorrhoids as the cause of the patient’s symptoms and colonoscopy to assure that there is no other colonic pathology that would take priority.^[3]

Anorectal manometry may reveal low resting sphincter pressure (especially in complete rectal prolapse) which predicts poor postoperative continence.^[2]