Academic journal article Journal of Eating Disorders

Rectal Prolapse Associated with Anorexia Nervosa: A Case Report and Review of the Literature

Academic journal article Journal of Eating Disorders

Rectal Prolapse Associated with Anorexia Nervosa: A Case Report and Review of the Literature

Article excerpt

Author(s): Nadine Mitchell[sup.1] and Mark L Norris[sup.2,3]


Anorexia nervosa (AN) is a potentially devastating disease that carries high rates of psychological and medical morbidity. Recognized as having the highest mortality rate among psychiatric diagnoses, AN is characterized by a pronounced state of starvation coupled with an intense fear of becoming fat or gaining weight[1]. Despite being under-weight, patients are uniformly distorted in their thoughts and feelings surrounding body image[1]. The prevalence of AN is approximately 1% in industrialized society with an overwhelming female predominance[2]. Although multiple etiological underpinnings have been implicated in disease origins, prevailing wisdom points to a multi-factorial cause implicating biological, psychological, social and environmental influences in vulnerable individuals[1].

Anorexia nervosa is one of a few mental health diagnoses that affects every organ system. If left untreated, severe medical morbidity and complications become the rule not the exception. Patients with AN often present with multiple secondary effects of starvation at the time of first assessment, including gastrointestinal (GI) complaints[3, 4]. In almost all cases, gut symptoms improve as patients are renourished and re-establish healthy weights. In extreme cases, severe GI complications such as rectal prolapse may be encountered as a consequence of the illness although formal study investigating the relative frequency of such occurrences is non-existent. The objective of the following article is to present a case-report on a young woman diagnosed with AN that developed rectal prolapse as a consequence of her disease and to conduct a formal review of all published literature investigating the frequency and prevalence of such occurrences in this population cohort.


A comprehensive literature review using Pubmed, Ovid and Medline databases examining articles relating to AN and rectal prolapse published between January 1st, 1969 and December 31st, 2011 was completed. A total of five medical subject headings (MeSH) were used in different groupings. These included AN, eating disorder (ED), bulimia nervosa (BN), rectal prolapse, and constipation. Relevant abstracts published in the English language were reviewed in depth along with corresponding reference sets.


A total of 83 abstracts were reviewed, of which 16 matched the objective of the study and were examined in-depth. Articles which focused on the finding of rectal prolapse and BN were more common than those with AN, although only 12 patients across all ED diagnoses were identified. In 1997 Malik et al. published a case series on seven patients with BN and hypothesized that chronically high intra-abdominal pressure associated with vomiting and straining, prolonged gut transit time, and constipation contributed to the rectal prolapse observed[5]. Guerdjikova and colleagues published a case history of another BN patient that experienced rectal prolapse although in this case, rectal purging (repeated finger evacuation of feces in the rectum) was suspected to be the primary contributor[6]. In 2001 Dreznik et al. published a case series describing three young women with AN and rectal prolapse[7]. The three women described were all diagnosed with AN at a young age, suffered from chronic constipation requiring routine laxatives or enemas, and experienced rectal prolapse four to seven years into the course of their respective eating disorder. Ravneet and Paradiso also presented a brief report describing a patient with AN that developed rectal prolapse following long-term laxative abuse[8].

Case report

A 16 year old female diagnosed three years prior with anorexia nervosa binge-purge subtype presented to the emergency department (ER) of a tertiary care hospital with a chief complaint of constipation. The patient's eating disorder history was significant for regular binging and purging in the six months prior to presenting, although at the time of initial diagnosis her eating disorder was restrictive in nature. …

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