Best approaches to rectal prolapse

A vast majority of patients are completely relieved from their symptoms or significantly helped with the appropriate treatment. Rectal prolapse is very often a chronic condition and is usually reduced when the patient is in a reclining position, pressing gently with the hands.

Patients should minimize the time spent sitting on the restroom and use an appropriate stool softener while they are awaiting evaluation of their condition by their physician.

The management of partial rectal prolapse in adults is similar to that of hemorrhoids. Treatment includes injectable sclerotherapy, mucosal ring or surgical repair and plastic repair of the anus and rectum. Occasionally repair of the anal sphincter is required.

Complete prolapse in children can usually be corrected by conservative means. These include a nutritious diet, avoidance of straining during defecation and immediate repositioning of the bowel after each prolapse to avoid swelling and possible difficulty in repositioning it within the anus. Children often overcome the disease when the natural curve of the sacrum becomes more concave and surgery may not be required.

Injections of agents, such as 5% phenol in almond oil into the hollow of the sacrum, have helped many patients with complete prolapse. These injections, however, should only be done by a person experienced in this procedure.

In adults with complete prolapse who are high-risk patients, abdominal surgery is often indicated. There are several surgical approaches. A relatively simple operation can correct the rectum in the hollow part of the sacrum. Another method is resection and low anastomosis of the sigmoid to the rectum. In patients who cannot tolerate abdominal surgery, the amputation and anastomosis can be done with an approach from the perineum or a relatively close suture with non-absorbable sutures from the anus. These sutures, which are usually made of wire, can be placed deep into the subcutaneous tissue of the rectoprosthetic area. In the same way, non-absorbable synthetic tape may be placed in place of the sutures. This method is performed under local anesthesia.