Rectal Prolapse: Next Step When Nonoperative Management Fails to Relieve Symptoms
Previous Treatment & Why Escalation Is Needed
Nonoperative management — including fiber and stool softeners, topical measures to reduce edema and assist reduction in incarcerated prolapse, and skin care — can palliate prolapse-associated symptoms but is unable to anatomically correct the prolapse itself. When palliation of fecal incontinence, pain, or constipation is not achieved, surgical correction becomes the appropriate next step.
Next-Step Treatment Approach
In patients with acceptable operative risk, the recommended approach involves surgical correction via a transabdominal route incorporating rectal fixation. The specific procedural options and the complete evidence-based protocol are available through the link below.
Clinical Goals
Elimination of the rectal prolapse and correction of associated functional abnormalities, including constipation and incontinence.
References
DOI: 10.1097/DCR.0000000000000889
- In patients with acceptable risk, the procedure of choice for the treatment of rectal prolapse should typically incorporate transabdominal rectal fixation.
- Rectopexy is a key component in the abdominal approach to rectal prolapse.
- Ventral mesh rectopexy offers an alternative approach to the repair of rectal prolapse with acceptable short- and long-term complication rates.
- The goals of surgery to correct rectal prolapse are 3-fold: 1) to eliminate the prolapse through either resection or restoration of normal anatomy, 2) to correct associated functional abnormalities of constipation or incontinence, and 3) to avoid the creation of de novo bowel dysfunction.
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