CONSULT REQUEST GUIDELINES                                                                         Print

Rectal Prolapse

Suggested Pre-Referral Evaluation and Management Guidelines Referral is indicated if the patient has symptomatic rectal prolapse. Patient should be on a bowel regimen for constipation, if applicable, and any pelvic floor dysfunction should be treated prior to referral. Women with pelvic organ prolapse and/or procedentia may be referred to the multidisciplinary Michigan Bowel Control Program for evaluation.

Would like report from the patient’s most recent colonoscopy if he/she has had one. If performed outside of the UMHS, report should be faxed prior to the clinic visit.
Suggested Additional Test/Management Prior to Specialty Visit Pelvic floor physical therapy for evaluating and treating pelvic floor dysfunction

Defecography may be of benefit
Patient Education/Information (includes preps) Michigan Bowel Control Program
Appointment Timeframe 4 weeks
How to Get Results to Consultant UMHS Patients: See MiChart
External Patients:
Reports and/or medical records can be faxed to 734-232-6189

CDs can be hand-carried to the appointment

Reports, medical records, CDs, and pathology slides can be mailed to:
Division of Colorectal Surgery
Attention: Jain Carver
2124 Taubman
1500 East Medical Center Drive, SPC 5343
Ann Arbor, MI 48109-5343
Clinic Contact Information Physicians: 800-962-3555
Patients: 734-615-7565
Clinic Location Sites Colorectal Surgery Clinic
Michigan Bowel Control Program Clinic
UM Consulting Physician Colorectal Surgery Physicians
Revised on: 04/22/2015



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