RECTAL PROLAPSE ASSOCIATED WITH BULIMIA-NERVOSA - REPORT OF 7 CASES

PURPOSE: Rectal prolapse is a condition in which, when complete, the f ull thickness of the rectal wall protrudes through the anus. Bulimia n ervosa is an eating disorder characterized by periodic food binges, wh ich are followed by purging. Purging usually takes the form of self-in duced vomiting, laxative abuse, and/or diuretic abuse. We report seven cases of rectal prolapse associated with bulimia nervosa. METHODS: Th e case histories of seven women with rectal prolapse and bulimia nervo sa, average age 79 (range 21-42) years, seen over a period of 11 years (1987-1997) were reviewed. An analysis of the clinical data, includin g history, presenting physical examination, surgical treatment, and ou tcome was performed. RESULTS: AU seven patients had a diagnosis of bul imia ner osa, made either before or with a diagnosis of rectal prolaps e. Rectal prolapse was confirmed in each patient at anorectal examinat ion. Five patients underwent sigmoid resection with proctopexy , one d ied before operative therapy, and one awaits further treatment. One of the five surgical patients had a recurrence that was managed by a per ineal rectosigmoidectomy. CONCLUSION: To our knowledge, despite extens ive review of both bulimia nervosa and rectal prolapse as seen in the medical literature, an association between the two has not been descri bed previously. Several aspects of bulimia nervosa. including constipa tion, laxative use, overzealous exercise, and increased intra-abdomina l pressure from forced vomiting are likely causes for the probable rel ationship with rectal prolapse. The possibility that an atypically you ng female presenting with rectal prolapse may also have bulimia nervos a should be taken into account by clinicians. This may assist the diag nosis of bulimia nervosa, a disease with multiple morbidities. Convers ely, a patient being treated for bulimia nervosa who develops anorecta l symptoms may come to earlier diagnosis and treatment for rectal prol apse.