Rectal Prolapse

Abstract

Prolapse, in general, is defined as: “A falling down of an organ or part… from its normal position.” Rectal prolapse is a “falling down” of the rectum so that it is outside the body. Its appearance is that of an erythematous, proboscis-like object and is a true intussusception of the rectum through the sphincters. It is associated with fecal incontinence, and in women, is associated with other pelvic floor abnormalities. More recently, with the benefit of cinedefecography, Broden and Snellman proposed that prolapse is actually a circumferential intussusception of the rectum. It is this theory that most investigators subscribe to. The majority of patients afflicted with rectal prolapse have a long history of constipation and straining. The disorder is more common in women, especially in older age groups. Affected men tend to be younger (20–40 years of age) and usually have a predisposing disorder (e.g., congenital anal atresia). A vast number of different procedures have been described to manage the disorder serving as testimony to the uncertain etiology of the disease and the resultant disagreement about optimal surgical therapy (Table 47.1).