Rectal Prolapse


UW Health Colon and Rectal Surgery specialists in Madison, Wisconsin provide comprehensive evaluation and surgical treatment of patients with rectal prolapse.


Rectal Prolapse


The cause of rectal prolapse is complex. Most likely it occurs when the pelvic muscules become weak and the colon above becomes redundant, thereby allowing the rectum to telescope on itself. This results in a protrusion of the rectum through the anus. Most commonly this occurs after having a bowel movement and is easily reduced either spontaneously or with gentle pressure.


In addition to the obvious prolapse through the rectum, some patients can suffer from internal prolapse. These patients can have rectal bleeding or findings of internal prolapse (also called intussusception) on a screening colonoscopy. Often these patients have constipation.


This condition is most common in elderly women but occurs in patients of all ages and sex.


Diagnosis of Rectal Prolapse


The diagnosis of rectal prolapse is not subtle and requires visual confirmation. Most commonly the patient is examined in the straining position and the prolapse is confirmed. Prior to any surgical intervention, a surgeon will order a colonoscopy or flexible sigmoidoscopy if you have not had one within the recommended time frame to ensure the prolapse is not a manifestation some other underlying pathology.


Patients with internal prolapse are often asked to undergo a radiological examination called a defecography. This is an x-ray study in which patients have radiographic contrast instilled in their rectum and have images taken of them while they are evacuating their bowels. This study allows for the clear visualization of the internal prolapse. In addition, patients also might require anal manometry.


Treatment of Rectal Prolapse


The treatment of rectal prolapse is tailored to each patient, but generally requires surgery. In the elderly, surgical high-risk patients, the most common operation is a perineal proctosigmoidectomy, also called an Altemeier operation. This operation does not require an abdominal incision and is generally safer for high-risk patients, but has a higher rate of recurrence.


Because of the higher rate of recurrence, patients who are healthy enough for an abdominal operation usually are offered that procedure, which entails removing a piece of redundant sigmoid colon and performing a rectopexy. This means the rectum will be completely mobilized and stretched up out of the pelvis. It will then be sewn to the sacrum so that it no longer prolapses down through the anus.