Internal rectal prolapse: Definition, assessment and management in 2016

J Visc Surg. 2017 Feb;154(1):21-28. doi: 10.1016/j.jviscsurg.2016.10.004. Epub 2016 Nov 16.

Abstract

Internal rectal prolapse (IRP) is a well-recognized pelvic floor disorder mainly seen during defecatory straining. The symptomatic expression of IRP is complex, encompassing fecal continence (56%) and/or evacuation disorders (85%). IRP cannot be characterized easily by clinical examination alone and the emergence of dynamic defecography (especially MRI) has allowed a better comprehension of its pathophysiology and led to the proposition of a severity score (Oxford score) that can guide management. Decision for surgical management should be multidisciplinary, discussed after a complete work-up, and only after medical treatment has failed. Information should be provided to the patient, outlining the goals of treatment, the potential complications and results. Stapled trans-anal rectal resection (STARR) has been considered as the gold standard for IRP treatment. However, inconsistent results (failure observed in up to 20% of cases, and fecal incontinence occurring in up to 25% of patients at one year) have led to a decrease in its indications. Laparoscopic ventral mesh rectopexy has substantial advantages in solving the functional problems due to IRP (efficacy on evacuation and resolution of continence symptoms in 65-92%, and 73-97% of patients, respectively) and is currently considered as the gold standard therapy for IRP once the decision to operate has been made.

Keywords: Constipation; Defecatory obstruction; Incontinence; Internal prolapse; Laparoscopic rectopexy; Management; Pelvic floor disorder; Rectum; Trans-anal rectal resection.

Publication types

  • Review

MeSH terms

  • Constipation / etiology
  • Defecography
  • Fecal Incontinence / etiology
  • Humans
  • Laparoscopy* / methods
  • Magnetic Resonance Imaging
  • Quality of Life
  • Rectal Prolapse / complications
  • Rectal Prolapse / diagnosis*
  • Rectal Prolapse / surgery*
  • Severity of Illness Index
  • Surgical Stapling* / methods
  • Treatment Outcome