What type of specialist should an elderly female patient with rectal prolapse consult?

Specialist Referral for Rectal Prolapse in Elderly Women

An elderly female patient with rectal prolapse should be referred to a colorectal surgeon as the primary specialist, with consideration for urogynecology consultation when concurrent pelvic organ prolapse is present.

Primary Specialist: Colorectal Surgeon

• Colorectal surgeons are the definitive specialists for managing rectal prolapse, as they perform both transabdominal and perineal surgical approaches for definitive repair 1, 2.
• The condition requires surgical expertise in rectal anatomy, pelvic floor reconstruction, and management of associated complications including fecal incontinence 3, 4.
• Colorectal surgeons can perform the necessary preoperative endoscopic screening, which is critical since patients with rectal prolapse have a 4.2-fold increased risk of colorectal cancer (5.7% prevalence vs 1.4% in age-matched controls) 1, 4.

When to Involve Urogynecology

• Urogynecology consultation is appropriate when concurrent pelvic organ prolapse is documented, as rectal prolapse frequently coexists with other pelvic floor defects 1, 4.
• In elderly women, rectal prolapse commonly presents with cystocele, enterocele, uterovaginal prolapse, or bladder prolapse, reflecting global pelvic floor failure 4, 5.
• Approximately 95% of patients with rectal prolapse have other pelvic floor support defects requiring multi-compartment evaluation 5.

Diagnostic Imaging Specialists

• Radiologists specializing in pelvic floor imaging may be consulted for dynamic cystocolpoproctography (CCP), which has 88% sensitivity for detecting internal rectal prolapse and excellent visualization of multi-compartment prolapse 1, 4.
• Contrast-enhanced CT should be performed to rule out colorectal malignancy, bowel obstruction, or perforation in complicated cases 1, 4.

Critical Clinical Pitfall

• Do not delay referral to colorectal surgery based on age alone—elderly patients can safely undergo prolapse repair with appropriate perioperative assessment 6.
• The mean length of surgery is approximately 81 minutes with no perioperative mortality in patients up to 92 years of age, and surgical treatment significantly improves quality of life 6.
• Failing to screen for colorectal cancer is a major oversight, as flexible sigmoidoscopy or colonoscopy should be routinely performed in all patients with symptomatic rectal prolapse 1.

Referral Algorithm

1. Initial referral: Colorectal surgery for all patients with external (complete) rectal prolapse 1, 2
2. Add urogynecology if physical examination reveals concurrent vaginal vault prolapse, cystocele, or enterocele 1, 5
3. Radiology consultation for dynamic imaging when clinical examination is inadequate or symptoms persist after initial treatment 1, 4
4. Coordinate simultaneous repair when multiple compartments are involved—procedures such as rectopexy with sigmoid resection can be combined with sacral colpopexy or sacrospinous suspension 5