Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Surgical management of rectal prolapse

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 552–561 (2007)Cite this article

Abstract

This article reviews the pathogenesis, clinical presentation and surgical management of rectal prolapse. Full-thickness prolapse of the rectum causes significant discomfort because of the sensation of the prolapse itself, the mucus that it secretes, and because it tends to stretch the anal sphincters and cause incontinence. Treatment of rectal prolapse is primarily surgical. Perineal surgical repairs are well tolerated, but are generally associated with higher recurrence rates. Abdominal repairs involve fixing the rectum to the sacrum by using either mesh or sutures, and tend to have the lowest recurrence rates. If significant preoperative constipation is present, a sigmoid resection can be performed at the time of rectopexy. For many patients, diarrhea and incontinence improve after surgery. Laparoscopic repair of rectal prolapse has similar morbidity and recurrence rates to open surgery, with attendant benefits of reduced length of hospital stay, postoperative pain and wound complications.

Key Points

  • The pathophysiology of complete rectal prolapse is not completely understood: despite this, effective surgical therapies are available

  • Patients with a preoperative history of constipation should be evaluated for sigmoid colectomy at the time of rectopexy

  • A preoperative history of diarrhea or incontinence is an important consideration that might affect the choice of surgical repair

  • Perineal surgical repairs are easily tolerated but generally associated with a higher recurrence rate than abdominal repairs

  • Laparoscopic surgical repairs seem to have an equivalent recurrence rate to open abdominal surgical repairs, and are associated with faster postoperative recovery, fewer complications, and overall cost savings

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: A prolapsed rectum demonstrating concentric folds at the apex of the prolapse.
Figure 2: Laparoscopic Wells rectopexy.
Figure 3: The management algorithm for rectal prolapse used in the Division of Colorectal Surgery at University Hospitals Case Medical Center.

Similar content being viewed by others

References

  1. Ramanujam PS and Venkatesh KS (1992) Management of acute incarcerated rectal prolapse. Dis Colon Rectum 35: 1154–1156

    Article  CAS  Google Scholar 

  2. Kairaluoma MV and Kellokumpu IH (2005) Epidemiologic aspects of complete rectal prolapse. Scand J Surg 94: 207–210

    Article  CAS  Google Scholar 

  3. Ripstein CB and Lanter B (1963) Etiology and surgical therapy of massive prolapse of the rectum. Ann Surg 157: 259

    Article  CAS  Google Scholar 

  4. Brodén B and Snellman B (1968) Procidentia of the rectum studied with cineradiography: a contribution to the discussion of causative mechanism. Dis Colon Rectum 11: 330–347

    Article  Google Scholar 

  5. Madiba TE et al. (2005) Surgical management of rectal prolapse. Arch Surg 140: 63–73

    Article  Google Scholar 

  6. Delaney CP and Senagore AJ (2005) Rectal Prolapse. In Current Therapy in Colon and Rectal Surgery, edn 2, 131–134 (Eds Fazio VW et al.) Philadelphia, PA: Elsevier, Mosby Inc.

    Chapter  Google Scholar 

  7. Madoff R and Mellgren A (1999) One hundred years of rectal prolapse surgery. Dis Colon Rectum 42: 441–450

    Article  CAS  Google Scholar 

  8. Madbouly KM et al. (2003) Clinically based management of rectal prolapse: comparison of the laparoscopic Wells procedure and laparoscopic resection with rectopexy. Surg Endosc 17: 99–103

    Article  CAS  Google Scholar 

  9. Luukkonen P et al. (1992) Abdominal rectopexy with sigmoidectomy vs rectopexy alone for rectal prolapse: a prospective, randomized study. Int J Colorect Dis 7: 219–22

    Article  CAS  Google Scholar 

  10. McKee RF et al. (1992) A prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gynecol Obstet 174: 145–148

    CAS  PubMed  Google Scholar 

  11. Tjandra J et al. (1993) Ripstein procedure is an effective treatment for rectal prolapse without constipation. Dis Colon Rectum 36: 501–507

    Article  CAS  Google Scholar 

  12. Brazzelli M et al. Surgery for complete rectal prolapse in adults. Cochrane Database of Systematic Reviews 1999, Issue 4. Art. No.: CD001758. DOI: 10.1002/14651858.CD001758

  13. Parks AG et al. (1977) Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 18: 656

    Article  CAS  Google Scholar 

  14. Spencer RJ (1984) Manometric studies in rectal prolapse. Dis Colon Rectum 27: 523–525

    Article  CAS  Google Scholar 

  15. Brodén G et al. (1988) Recovery of the internal anal sphincter following rectopexy: a possible explanation for continence improvement. Int J Colorect Dis 3: 23–28

    Article  Google Scholar 

  16. Kariv Y et al. (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse. Surg Endosc 20: 35–42

    Article  CAS  Google Scholar 

  17. Sullivan E et al. (2001) Total pelvic mesh repair: a ten-year experience. Dis Colon Rectum 44: 857–863

    Article  CAS  Google Scholar 

  18. Maglinte DD et al. (1999) Association of compartment defects in pelvic floor dysfunction. Am J Roentgenol 172: 439–444

    Article  CAS  Google Scholar 

  19. Rentsch M et al. (2001) Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology. Dis Colon Rectum 44: 999–1007

    Article  CAS  Google Scholar 

  20. Kim DS et al. (1999) Complete rectal prolapse: Evolution of management and results. Dis Colon Rectum 42: 460–466

    Article  CAS  Google Scholar 

  21. Corman ML (2005) Chapter 17: Rectal Prolapse, Solitary Rectal Ulcer, Syndrome of the Descending Perineum, and Rectocele. In Colon and Rectal Surgery, edn 5, 499–554 (Ed. Corman ML) Philadelphia, PA: Lippincott Williams and Wilkins

    Google Scholar 

  22. Habr-Gama A et al. (2006) Rectal procidentia treatment by perineal rectosigmoidectomy combined with levator ani repair. Hepatogastroenterology 53: 213–217

    PubMed  Google Scholar 

  23. Frykman HM and Goldberg SM (1969) The surgical treatment of rectal procidentia. Surg Gynecol Obstet 129: 1225–1230

    CAS  PubMed  Google Scholar 

  24. Lake S et al. (1984) Management of pelvic sepsis after Ivalon rectopexy. Dis Colon Rectum 27: 589–590

    Article  CAS  Google Scholar 

  25. Nigro ND (1970) A sling operation for rectal prolapse. Proc R Soc Med 63: 106

    PubMed  PubMed Central  Google Scholar 

  26. Wells C (1959) New operation for rectal prolapse. J R Soc Med 52: 602–603

    CAS  Google Scholar 

  27. Orr TG (1947) A suspension operation for prolapse of the rectum. Ann Surg 126: 833–840

    Article  Google Scholar 

  28. Duepree HJ et al. (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy vs. laparotomy. J Am Coll Surg 197: 177–181

    Article  Google Scholar 

  29. Kiran RP et al. (2004) Operative blood loss and use of blood products after laparoscopic and conventional open colorectal operations. Arch Surg 139: 39–42

    Article  Google Scholar 

  30. Senagore AJ et al. (2003) Advantageous of laparoscopic colectomy in older patients. Arch Surg 138: 252–256

    Article  Google Scholar 

  31. Lechaux D et al. (2005) Laparoscopic rectopexy for full thickness rectal prolapse: a single-institution retrospective study evaluating surgical outcomes. Surg Endosc 19: 514–518

    Article  CAS  Google Scholar 

  32. Kessler H et al. (1999) Successful treatment of rectal prolapse by laparoscopic suture rectopexy. Surg Endosc 13: 858–861

    Article  CAS  Google Scholar 

  33. Rose J et al. (2002) Laparoscopic treatment of rectal prolapse: experience gained in a prospective multicenter study. Lang Arch Surg 387: 130–137

    Article  CAS  Google Scholar 

  34. D'Hoore A et al. (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91: 1500–1505

    Article  CAS  Google Scholar 

  35. Delaney CP et al. (2007) Wells Rectopexy. In Operative Techniques in Laparoscopic Colorectal Surgery. Philadelphia, PA: Lippincott Williams and Wilkins

    Google Scholar 

  36. Kairaluoma M et al. (2003) Open vs laparoscopic surgery for rectal prolapse: a case-controlled study assessing short-term outcome. Dis Colon Rectum 46: 353–360

    Article  Google Scholar 

  37. Demirbas S et al. (2004) Early outcomes of laparoscopic procedures performed on military personnel with total rectal prolapse and follow-up. Surg Laparosc Endosc Percutan Tech 14: 194–200

    Article  Google Scholar 

  38. Demirbas S et al. (2005) Comparison of laparoscopic and open surgery for total rectal prolapse. Surg Today 35: 446–452

    Article  Google Scholar 

  39. Ashari L et al. (2005) Laparoscopically-assisted resection rectopexy for rectal prolapse: ten years' experience. Dis Colon Rectum 48: 982–987

    Article  Google Scholar 

  40. Solomon M et al. (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89: 35–39

    Article  CAS  Google Scholar 

  41. Salkeld G et al. (2004) Economic impact of laparoscopic versus open abdominal rectopexy. Br J Surg 91: 1188–1191

    Article  CAS  Google Scholar 

  42. Boccasanta P et al. (1998) Comparison of laparoscopic rectopexy with open technique in the treatment of complete rectal prolapse. Surg Laparosc Endosc 8: 460–465

    Article  CAS  Google Scholar 

  43. Purkayastha S et al. (2005) A comparison of open v. laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a meta-analysis. Dis Colon Rectum 48: 1930–1940

    Article  Google Scholar 

  44. Ayav A et al. (2005) Robotic-assisted pelvic organ prolapse surgery. Surg Endosc 19: 1200–1203

    Article  CAS  Google Scholar 

  45. Munz Y et al. (2004) Robotic assisted rectopexy. Am J Surg 187: 88–92

    Article  Google Scholar 

  46. Delaney CP et al. (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46: 1633–1639

    Article  Google Scholar 

  47. Digiuro G et al. (2006) How accurate are published recurrence rates after rectal prolapse surgery? A meta-analysis of individual patient data. Am J Surg 191: 773–778

    Article  Google Scholar 

  48. Steele S et al. (2006) Management of recurrent rectal prolapse: surgical approach influences outcome. Dis Colon Rectum 49: 440–445

    Article  Google Scholar 

  49. Novell JR et al. (1994) Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full-thickness rectal prolapse Br J Surg 81: 904–906

    Article  CAS  Google Scholar 

  50. Khanna AK et al. (1996) Simplified sutured sacral rectopexy for complete rectal prolapse in adults. Eur J Surg 162: 143–146

    CAS  PubMed  Google Scholar 

  51. Watts JD et al. (1999) The management of procidentia: 30 years' experience. Dis Colon Rectum 42: 460–469

    Article  Google Scholar 

  52. Roberts PL et al. (1988) Ripstein procedure. Lahey Clinic experience: 1963–1985. Arch Surg. 123: 554–557

    Article  CAS  Google Scholar 

  53. Mann CV and Hoffman C (1988) Complete rectal prolapse: the anatomical and functional results of treatment by an extended abdominal rectopexy. Br J Surg 75: 34–37

    Article  CAS  Google Scholar 

  54. Zittel TT et al. (2000) Functional results after laparoscopic rectopexy for rectal prolapse. J Gastrointest Surg 4: 632–641

    Article  CAS  Google Scholar 

  55. Watts AMI and Thompson MR (2000) Evaluation of Delorme's procedure as a treatment for full-thickness rectal prolapse. Br J Surg 87: 218–222

    Article  CAS  Google Scholar 

  56. Lechaux JP et al. (2001) Prosthetic rectopexy to the pelvic floor and sigmoidectomy for rectal prolapse. Am J Surg 182: 465–469

    Article  CAS  Google Scholar 

  57. Altemeier WA et al. (1971) Nineteen years experience with the one-stage perineal repair of rectal prolapse. Ann Surg 173: 993–1006

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. EL Marderstein is an Assistant Professor of Surgery in the Division of Colorectal Surgery and Department of Surgery, Vice Chairman of Surgery and Chief of the Division of Colorectal Surgery at University Hospitals Case Medical Center. CPD is also Director of the Center for Surgical Innovation at University Hospitals Case Medical Center, and CP Delaney is Professor of Surgery, Cleveland, OH, USA.,

    Eric L Marderstein & Conor P Delaney

Authors
  1. Eric L Marderstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Conor P Delaney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Conor P Delaney.

Ethics declarations

Competing interests

CP Delaney serves as a consultant to Ethicon Endosurgery and US Surgical. EL Marderstein declared no competing interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marderstein, E., Delaney, C. Surgical management of rectal prolapse. Nat Rev Gastroenterol Hepatol 4, 552–561 (2007). https://doi.org/10.1038/ncpgasthep0952

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpgasthep0952

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing