Rectal prolapse

Definition

• • is a pelvic floor disorder;

  • physiology - proximal pudendal nerve injury → pelvic floor weakness.

    • Direct trauma, obstetric injury, neuropathic diseases (diabetes), neoplasms;

Epidemiology

• • ♀ > ♂(6:1)

  • bimodal distribution - <3 years and >70;

Clinical

• • degrees of prolapse

    • Internal intussusception or occult rectal prolapse (or prolapse of the rectal wall without protrusion through the anus)

    • Procidentia (or complete protrusion of all layers of the rectum)

    • Mucosal prolapse.

  • Sx - anal “mass” sensation, reduces with pressure; protrusion w/ ↑ abdominal pressure (coughing, defecation); Fecal incontinence (50-75%); tenesmus, rectal pressure.

  • P/E - concentric folds

Treatment → operative repair

• • Abdominal approach (open or laparoscopic) - involves resection of redundant sigmoid colon and rectopexy; reserved for pts who can tolerate abdominal surgery; low recurrence rate;

  • Perineal approach (Altemeier procedure) - involves proctosigmoidectomy with full-thickness resection of redundant rectum while prolapsed; + anterior levatorplasty to correct the weakness of the pelvic floor;