From the Guidelines
Treatment for a prolapsed rectum should prioritize manual reduction as the first step, followed by surgical intervention for recurrent or severe cases, with the choice of surgery depending on the patient's characteristics and the surgeon's expertise, as suggested by the most recent guidelines 1.
Initial Management
For mild cases of prolapsed rectum, manual reduction is the initial approach, where gentle pressure is applied to push the rectum back into place using a lubricated, gloved finger. This method is recommended for patients without signs of ischemia or perforation 1.
- After reduction, patients should avoid straining during bowel movements by using stool softeners like docusate sodium (100mg twice daily) or polyethylene glycol (17g daily).
- Increasing dietary fiber (25-30g daily) and drinking plenty of water (2-3 liters daily) can also help prevent recurrence.
- Sitz baths for 10-15 minutes several times daily can reduce inflammation and discomfort.
Surgical Intervention
For recurrent or severe prolapses, surgical intervention may be necessary, with procedures including:
- Rectopexy, where the rectum is secured to the sacrum.
- Delorme's procedure, which removes excess tissue and tightens the sphincter muscles. The choice between abdominal and perineal procedures should be based on the patient's characteristics and the surgeon's skills and expertise 1.
- In patients with complicated rectal prolapse and signs of shock or gangrene/perforation of prolapsed bowel, immediate surgical treatment is recommended 1.
- In patients with complicated rectal prolapse and bleeding, acute bowel obstruction, or failure of non-operative management, urgent surgical treatment is suggested 1.
Pharmacological Regimen
In patients with strangulated rectal prolapse, empiric antimicrobial therapy should be administered due to the risk of intestinal bacterial translocation, with the regimen based on the patient's clinical condition, individual risk for MDRO, and local resistance epidemiology 1.
Underlying Cause
Addressing the underlying cause of the prolapse, such as weakened pelvic floor muscles from chronic constipation, straining, pregnancy, or aging, is essential for preventing recurrence.
- Conservative and/or biofeedback therapy can be used to correct underlying dyssynergia in asymptomatic Grade 1–2 rectal prolapse 1.
From the Research
Treatment Options for Prolapsed Rectum
The treatment for a prolapsed rectum can vary depending on the severity and underlying cause of the condition. Some of the treatment options include:
- Conservative management, which is mainly directed at the underlying conditions 2
- Surgical intervention, which may be required for recurrent rectal prolapse refractory to conservative measures 2
- Perirectal injection with a sclerosing agent, which appears to be a simple, less invasive, and highly effective approach 2
- Laparoscopic posterior rectopexy, which has been shown to be feasible and has the advantage of being a minimally invasive technique 3
- Deep retrorectal dissection/suturing without mesh, which can be used to treat gross persistent rectal prolapse 4
- Use of an anal plug as a noninvasive alternative in patients with contraindication of surgery 5
Surgical Approaches
Surgical options for rectal prolapse include:
- Abdominal versus perineal approach 6
- Minimally invasive versus open approach 6
- Posterior versus ventral rectopexy +/- sigmoidectomy 6
- Laparoscopic rectopexy, which has been shown to have good results in the long-term 3
Considerations for Treatment
When determining the best treatment approach for a patient with rectal prolapse, considerations should include: