Rectal Prolapse



Rectal prolapsed (or procidentia) is a protrusion of a full-thickness portion of the rectum through the anal sphincter, usually associated with a long history of constipation and straining, and, in women, with other pelvic floor abnormalities. Although uncommon, rectal prolapse is more frequent in elderly women. The condition is related to a concentric intussusception of the rectum secondary to weakness of the surrounding structures and exacerbated by constipation. The symptoms reflect the degree of progression of the condition: in the early stage, the main complaint is bowel regulation and constipation; in later stage, a permanently extruded rectum becomes excoriated and ulcerated, along with incontinence, constipation, and impaired anorectal sensation. Multiple surgical procedures are utilized to treat this condition, either through a perineal or trans-abdominal approach, with the former approach adopted for elderly patients with multiple comorbidities. Operation indicated for healthy adults is abdominal rectopexy with or without sigmoidectomy. While the perineal procedures have a low morbidity and mortality rate, recurrence rate may be up to 22%. Abdominal operations, despite significant morbidity, provide a lower recurrence rate.


Pelvic Floor Fecal Incontinence Bulimia Nervosa Rectal Prolapse Rectal Wall 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wu JS. Rectal prolapse: a historical perspective. Curr Probl Surg. 2009;46:602–716.PubMedCrossRefGoogle Scholar
  2. 2.
    Moodie R. Paleopathology. An introduction to the study of ancient evidences of disease. Urbana: University of Illinois Press; 1923. p. 400–1.Google Scholar
  3. 3.
    Karulf RE, Madoff RD, Goldberg SM. Rectal prolapse. Curr Probl Surg. 2001;38:771–832.PubMedGoogle Scholar
  4. 4.
    Mikulicz J. Untitled. Arch Klin Chir. 1888;38:74.Google Scholar
  5. 5.
    Altemeier WA, Culbertson WR, Schowengerdt C, et al. Nineteen years’ experience with the one-stage perineal repair of rectal prolapse. Ann Surg. 1971;73:993–1006.CrossRefGoogle Scholar
  6. 6.
    Altemeier WA, Culbertson WR, Alexander JW. One-stage perineal repair of rectal prolapse. Twelve years’ experience. Arch Surg. 1964;89:6–16.PubMedCrossRefGoogle Scholar
  7. 7.
    Theuerkauf FJ, Beahrs OH, Hill JR. Rectal prolapse. Causation and surgical treatment. Ann Surg. 1970;171:819–35.PubMedCrossRefGoogle Scholar
  8. 8.
    Beahrs OH, Vandertoll DJ, Baker NH. Complete rectal prolapse: an evaluation of surgical treatment. Ann Surg. 1965;161:221–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Moschcowitz A. The pathogenesis, anatomy and cure of prolapse of the rectum. Surg Gynecol Obstet. 1912;15:7–21.Google Scholar
  10. 10.
    Broden B, Snellman B. Procidentia of the rectum studied with cineradiography. A contribution to the discussion of causative mechanism. Dis Colon Rectum. 1968;11:330–47.PubMedCrossRefGoogle Scholar
  11. 11.
    Parks AG, Swash M, Urich H. Sphincter denervation in anorectal incontinence and rectal prolapse. Gut. 1977;18:656–65.PubMedCrossRefGoogle Scholar
  12. 12.
    Corman M. Rectal prolapse, solitary rectal ulcer, syndrome of descending perineum, and rectocele. In: Corman ML, editor. Colon and rectal surgery. 4th ed. Philadelphia: Lippincott, Williams & Wilkins; 2005. p. 401–48.Google Scholar
  13. 13.
    Gordon PH. Rectal procidentia. In: Gordon PH, Nivatvongs S, editors. Principles and practice of surgery for the colon, rectum and anus. 2nd ed. St Louis: Quality Medical Publishing; 1999. p. 503–40.Google Scholar
  14. 14.
    Farouk R, Duthie GS. The evaluation and treatment of patients with rectal prolapse. Ann Chir Gynaecol. 1997;86:279–84.PubMedGoogle Scholar
  15. 15.
    Henry JB, Drummond LM, Kolb P. Obsessive-compulsive disorder and rectal prolapse. Eur J Gastroenterol Hepatol. 2006;18:797–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Malik M, Stratton J, Sweeney WB. Rectal prolapse associated with bulimia nervosa: report of seven cases. Dis Colon Rectum. 1997;40:1382–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Dreznik Z, Vishne TH, Kristt D, et al. Rectal prolapse: a possibly underrecognized complication of anorexia nervosa amenable to surgical correction. Int J Psychiatry Med. 2001;31:347–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Leighton JA, Valdovinos MA, Pemberton JH, et al. Anorectal dysfunction and rectal prolapse in progressive systemic sclerosis. Dis Colon Rectum. 1993;36:182–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Hovey MA, Metcalf AM. Incarcerated rectal prolapse—rupture and ileal evisceration after failed reduction: report of a case. Dis Colon Rectum. 1997;40:1254–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Birnbaum EH, Stamm L, Rafferty JF, et al. Pudendal nerve terminal motor latency influences surgical outcome in treatment of rectal prolapse. Dis Colon Rectum. 1996;39:1215–21.PubMedCrossRefGoogle Scholar
  21. 21.
    Neill ME, Parks AG, Swash M. Physiological studies of the anal sphincter musculature in faecal incontinence and rectal prolapse. Br J Surg. 1981;68:531–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Myers JO, Rothenberger DA. Sugar in the reduction of incarcerated prolapsed bowel. Report of two cases. Dis Colon Rectum. 1991;34:416–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Hamalainen KJ, Raivio P, Antila S, et al. Biofeedback therapy in rectal prolapse patients. Dis Colon Rectum. 1996;39:262–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Agachan F, Pfeifer J, Joo JS, et al. Results of perineal procedures for the treatment of rectal prolapse. Am Surg. 1997;63:9–12.PubMedGoogle Scholar
  25. 25.
    Ramanujam PS, Venkatesh KS, Fietz MJ. Perineal excision of rectal procidentia in elderly high-risk patients. A ten-year experience. Dis Colon Rectum. 1994;37:1027–30.PubMedCrossRefGoogle Scholar
  26. 26.
    Williams JG, Rothenberger DA, Madoff RD, et al. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum. 1992;35:830–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Friedman R, Muggia-Sulam M, Freund HR. Experience with the one-stage perineal repair of rectal prolapse. Dis Colon Rectum. 1983;26:789–91.PubMedCrossRefGoogle Scholar
  28. 28.
    Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg. 2005;140:63–73.PubMedCrossRefGoogle Scholar
  29. 29.
    Tou S, Brown SR, Malik AI, et al. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev. 2008:CD001758.Google Scholar
  30. 30.
    Speakman CT, Madden MV, Nicholls RJ, et al. Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study. Br J Surg. 1991;78:1431–3.PubMedCrossRefGoogle Scholar
  31. 31.
    Senagore AJ. Management of rectal prolapse: the role of laparoscopic approaches. Semin Laparosc Surg. 2003;10:197–202.PubMedGoogle Scholar
  32. 32.
    Lechaux D, Trebuchet G, Siproudhis L, et al. Laparoscopic rectopexy for full-thickness rectal prolapse: a single-institution retrospective study evaluating surgical outcome. Surg Endosc. 2005;19:514–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Sajid MS, Siddiqui MR, Baig MK. Open vs laparoscopic repair of full-thickness rectal prolapse: a re-meta-analysis. Colorectal Dis. 2010;12:515–25.PubMedCrossRefGoogle Scholar
  34. 34.
    Delaney CP, Lynch AC, Senagore AJ, et al. Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum. 2003;46:1633–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Munz Y, Moorthy K, Kudchadkar R, et al. Robotic assisted rectopexy. Am J Surg. 2004;187:88–92.PubMedCrossRefGoogle Scholar
  36. 36.
    de Hoog DE, Heemskerk J, Nieman FH, et al. Recurrence and functional results after open versus conventional laparoscopic versus robot-assisted laparoscopic rectopexy for rectal prolapse: a case-control study. Int J Colorectal Dis. 2009;24:1201–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Ayav A, Bresler L, Hubert J, et al. Robotic-assisted pelvic organ prolapse surgery. Surg Endosc. 2005;19:1200–3.PubMedCrossRefGoogle Scholar
  38. 38.
    Maeso S, Reza M, Majol JA, et al. Efficacy of the da vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg. 2010;252:254–62.PubMedCrossRefGoogle Scholar
  39. 39.
    Zimmern A, Prasad L, Desouza A, et al. Robotic colon and rectal surgery: a series of 131 cases. World J Surg. 2010;34:1954–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Kim DS, Tsang CB, Wong WD, et al. Complete rectal prolapse: evolution of management and results. Dis Colon Rectum. 1999;42:460–6;discussion 466–9.Google Scholar
  41. 41.
    Johansen OB, Wexner SD, Daniel N, et al. Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum. 1993;36:767–72.PubMedCrossRefGoogle Scholar
  42. 42.
    Watkins BP, Landercasper J, Belzer GE, et al. Long-term follow-up of the modified Delorme procedure for rectal prolapse. Arch Surg. 2003;138:498–502; discussion 502–3.Google Scholar
  43. 43.
    Senapati A, Nicholls RJ, Thomson JP, et al. Results of Delorme’s procedure for rectal prolapse. Dis Colon Rectum. 1994;37:456–60.PubMedCrossRefGoogle Scholar
  44. 44.
    Tsunoda A, Yasuda N, Yokoyama N, et al. Delorme’s procedure for rectal prolapse: clinical and physiological analysis. Dis Colon Rectum. 2003;46:1260–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Oliver GC, Vachon D, Eisenstat TE, et al. Delorme’s procedure for complete rectal prolapse in severely debilitated patients. An analysis of 41 cases. Dis Colon Rectum. 1994;37:461–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Division of Colo-rectal Surgery, Department of SurgerySaint Peter’s University HospitalEast BrunswickUSA
  2. 2.Department of General SurgeryRobert Wood Johnson University Hospital/UMDNJNew BrunswickUSA

Personalised recommendations