Rectal prolapse occurs when the walls of the rectum, the final section of the large intestine, slip down and sometimes protrude outside the body through the anus. This slippage is caused by a weakening of the muscles and ligaments that normally hold the rectum in place within the pelvis. The condition is treatable but requires professional medical evaluation. A full-thickness prolapse, where the entire rectal wall protrudes, typically requires surgical correction to prevent recurrence.
Initial Consultation and Referral
The first step for anyone who suspects rectal prolapse is to consult their Primary Care Physician (PCP). The PCP performs an initial physical examination and takes a detailed medical history. During this visit, the doctor will likely perform a digital rectal exam and may ask the patient to strain to evaluate the prolapse.
This initial assessment rules out similar conditions, such as hemorrhoids or polyps, which require different treatments. The PCP also determines the urgency of the situation; for instance, a prolapse that is irreducible or causes severe bleeding or signs of tissue death requires immediate attention. Once rectal prolapse is suspected, the PCP issues a referral to a specialized surgeon for definitive diagnosis and treatment planning.
The Key Specialists for Rectal Prolapse Treatment
Definitive treatment for rectal prolapse is nearly always surgical, meaning the primary specialist is a surgeon with specific training. The most qualified specialist for both diagnosis and surgical management is the Colorectal Surgeon. This specialist, formerly known as a Proctologist, has advanced training focused exclusively on the colon, rectum, and anus.
Colorectal surgeons are experts in the various surgical techniques used to repair rectal prolapse, including abdominal procedures like rectopexy and perineal (rectal) approaches such as the Altemeier procedure. Their expertise covers the full spectrum of anorectal disorders, ensuring they can manage the condition and any related issues like fecal incontinence. They also perform a full range of diagnostic tests in their practice.
A Gastroenterologist specializes in the entire digestive tract and may be involved in early stages to perform a colonoscopy or manage related gastrointestinal issues like severe constipation. While skilled in diagnosis, they typically refer patients to a Colorectal Surgeon for surgical correction. If the rectal prolapse is part of a broader pelvic floor dysfunction, especially in women, a Urogynecologist may also be part of the care team.
Urogynecologists specialize in female pelvic medicine and reconstructive surgery, treating conditions like pelvic organ prolapse and urinary incontinence that often accompany rectal prolapse. Because rectal prolapse is frequently associated with other pelvic floor weaknesses, a combined surgical approach with both a Colorectal Surgeon and a Urogynecologist may be necessary. This coordination ensures all interconnected pelvic issues are addressed simultaneously.
Diagnostic Testing and Planning the Treatment Path
After the initial referral, the specialist orders specific tests to plan the most effective treatment. A Colonoscopy is often performed to inspect the entire colon and rule out underlying pathology, such as tumors or polyps, which can mimic or contribute to prolapse. This ensures the large intestine is healthy before a repair is attempted.
Anorectal Manometry measures the strength and coordination of the anal sphincter muscles and the rectum’s function. This test provides details about muscle weakness or nerve damage contributing to the prolapse or associated incontinence. Defecography, performed with X-ray or Magnetic Resonance Imaging (MRI), is a dynamic study that visualizes the prolapse as the patient strains to defecate.
The results of these specialized tests determine the treatment path, which is typically surgical for full-thickness prolapse. Non-surgical options, such as dietary changes, stool softeners, and biofeedback for muscle re-training, are usually reserved for early-stage or mucosal prolapse. For a complete prolapse, the surgical plan is tailored based on the patient’s age and overall health, choosing either an abdominal approach, which has a lower recurrence rate, or a perineal approach, which is less invasive and often preferred for older or frail patients.