Management of Mild Rectal Prolapse
For mild (asymptomatic grade 1-2) rectal prolapse, initiate pelvic floor biofeedback therapy as first-line treatment without surgical intervention. 1
Initial Conservative Management
Pelvic floor muscle training (PFMT) is the cornerstone of treatment for mild rectal prolapse, addressing the underlying pelvic floor dysfunction that contributes to prolapse development. 2, 1
Evidence for Conservative Therapy
- PFMT increases the chance of improvement in prolapse stage by 17% compared to no treatment, based on pooled data from randomized trials. 3
- All trials measuring prolapse symptoms showed greater improvement in the PFMT group compared to control groups. 3
- Pelvic floor muscle function improves significantly with supervised PFMT, with benefits demonstrated in both anatomical and symptomatic outcomes after six months of supervised therapy. 3
Specific Conservative Interventions
- Pelvic floor biofeedback therapy should be the primary intervention to correct underlying dyssynergia in patients with asymptomatic grade 1-2 prolapse. 1
- If biofeedback fails, consider medical management with suppositories and enemas to facilitate defecation and reduce straining. 2
- Address underlying conditions that increase intraabdominal pressure or contribute to pelvic floor weakness. 4
Pre-Treatment Evaluation
Before initiating conservative management, complete the following workup:
- Obtain colonoscopy or flexible sigmoidoscopy to rule out colorectal malignancy, as rectal prolapse patients have a 4.2-fold increased risk of rectosigmoid cancer compared to age-matched controls. 1
- Assess for associated pelvic floor disorders including fecal incontinence, constipation, and other pelvic organ prolapse. 2
When Surgery Becomes Necessary
Surgery is not indicated for mild, asymptomatic grade 1-2 prolapse. 1 However, escalate to surgical consultation if:
- Conservative management fails after adequate trial (typically 6 months of supervised PFMT). 3
- Prolapse progresses to symptomatic grade 3-4 despite conservative therapy. 2
- Incarceration, strangulation, or ischemia develops (emergency surgical indication). 1
Critical Pitfall to Avoid
Do not assume that anatomic correction correlates with symptom improvement—underlying functional disorders may persist despite successful anatomic repair, making patient selection for any future surgical intervention crucial. 2, 1 This reinforces the importance of maximizing conservative therapy first, as symptoms may not improve even with surgical correction.