Rectal prolapse continues to be problematic for both patients and surgeons alike, in part because of increased recurrence rates despite several well-described operations. Patients should be aware that although the prolapse will resolve with operative therapy, functional results may continue to be problematic. This article describes the recommended evaluation, role of adjunctive testing, and outcomes associated with both perineal and abdominal approaches.
Key points
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Rectal prolapse affects patients of both genders and all ages.
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A detailed history and physical examination is paramount, with attention on risk factors for underlying disease, functional problems with fecal incontinence or constipation, as well as a complete evaluation for concomitant defects that may need to be addressed at the time or following repair of the prolapse.
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Adjunctive testing is not often required, other than in patients with significant constipation or incontinence, and those with risk factors for other diseases (ie, colonoscopy in an appropriate patient).
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The mainstay of operative therapy involves both transabdominal and perineal techniques (via open and minimally invasive approaches), and may include fixation through sutures, tacks, or mesh. In general, transabdominal repairs are associated with lower recurrence rates, and transperineal ones are reserved for those at high risk with multiple comorbidities.
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Patients should be counseled that their functional problems may or may not improve, even following successful repair.
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