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Rectal prolapse

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of rectal prolapse are prepared by our editorial team based on guidelines from the American College of Radiology (ACR 2021), the World Society of Emergency Surgery (WSES/AAST 2021), and the American Society of Colon and Rectal Surgeons (ASCRS 2017). ...
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Diagnostic investigations

Clinical history and physical examination: as per ASCRS 2017 guidelines, elicit a complete history and perform a physical examination, focusing on signs and symptoms of rectal prolapse, on anal sphincter structure and function, and underlying conditions.
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  • Laboratory testing

  • Anal physiologic testing

  • Diagnostic imaging

Medical management

Conservative management: as per AAST/WSES 2021 guidelines, consider attempting conservative measures and gentle manual reduction under mild sedation or anesthesia in patients with incarcerated rectal prolapse without signs of ischemia or perforation.
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  • Antibiotics

Surgical interventions

Timing for surgery: as per AAST/WSES 2021 guidelines, avoid delaying surgery in order to attempt a conservative management in hemodynamically unstable patients with complicated rectal prolapse.
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  • Choice of surgical approach

  • Abdominal approaches (posterior dissection)

  • Abdominal approaches (posterior rectopexy)

  • Abdominal approaches (posterior mesh rectopexy)

  • Abdominal approaches (ventral rectopexy)

  • Perineal approaches (mucosal sleeve resection)

  • Perineal approaches (perineal rectosigmoidectomy)