Rectal prolapse is a medical condition where the walls of the rectum, the final section of the large intestine, slip out of their normal position. This slippage causes the rectal tissue to protrude through the anus, sometimes resembling a mass or a bulge. The condition results from a weakening of the muscles and ligaments that hold the rectum in place within the pelvic cavity.
Accurate diagnosis and effective long-term treatment require a specialized team of medical professionals. Treatment options range from simple lifestyle adjustments to complex surgical repair, necessitating a coordinated approach involving multiple healthcare providers.
Initial Consultation and Referral
Diagnosis typically begins with a Primary Care Physician (PCP), Family Doctor, or Internal Medicine practitioner. These providers conduct a thorough medical history review and a preliminary physical examination. They often perform a digital rectal exam and ask the patient to strain, which helps confirm the presence of the prolapse or differentiate it from other anorectal conditions like hemorrhoids.
While a PCP may initiate conservative management, such as recommending a high-fiber diet and stool softeners, they do not manage definitive treatment. If the physical exam confirms a suspected prolapse or symptoms persist, the PCP organizes a referral to a specialist. This ensures the patient receives the specialized expertise and diagnostic tools required for a detailed evaluation.
Specialized Diagnosis and Non-Surgical Options
Once referred, a Gastroenterologist confirms the diagnosis and rules out other conditions. This specialist focuses on the entire digestive tract and performs internal evaluations for precise assessment. A colonoscopy is often performed to examine the colon and rectum, ensuring symptoms are not caused by polyps, inflammatory bowel disease, or malignancy.
To understand pelvic floor mechanics, the Gastroenterologist may order specialized tests. Defecography uses imaging to visualize the rectum’s movement during a simulated bowel movement, determining the extent of the prolapse. Anorectal manometry measures the strength and coordination of the anal sphincter muscles.
For early-stage or mucosal prolapse, the Gastroenterologist may oversee non-surgical management. This includes targeted biofeedback therapy to help patients strengthen pelvic floor muscles and improve coordination.
The Colorectal Surgeon: Definitive Treatment
The Colorectal Surgeon provides definitive treatment for full-thickness rectal prolapse. This surgeon has advanced training in treating diseases of the colon, rectum, and anus, and their expertise is required because most complete prolapses need surgical correction. The choice of procedure depends on the patient’s age, overall health, and the extent of the prolapse.
Surgical approaches are categorized into abdominal and perineal. The abdominal approach, often a rectopexy, involves repositioning the rectum and securing it to the sacrum, often using mesh. This method is preferred for younger, healthier patients because it offers the lowest recurrence rate and can be performed using minimally invasive techniques.
The perineal approach is performed through the anus and is reserved for elderly or frail patients who cannot tolerate major abdominal surgery. Procedures like the Altemeier procedure involve excising the prolapsed portion of the rectum from below. Although these procedures have a higher recurrence rate, they carry less surgical risk and may be performed under regional anesthesia.
Supporting Specialists for Complex Cases
Managing rectal prolapse often requires a multidisciplinary approach, especially when co-existing with other pelvic floor disorders.
Urologists and Urogynecologists
A Urologist or Urogynecologist may be involved if the patient experiences urinary incontinence or bladder prolapse (cystocele). Since pelvic floor weakness can affect the urinary system, these specialists provide expertise in bladder function and anatomy. A Urogynecologist also collaborates on cases involving concurrent uterine or vaginal vault prolapse. They work with the Colorectal Surgeon to plan a comprehensive surgical strategy addressing all pelvic floor defects.
Physical Therapists
Physical Therapists specializing in pelvic floor rehabilitation play a supporting role in both non-surgical and postoperative recovery. These therapists use specialized exercises and biofeedback training to strengthen the levator ani muscles and other pelvic floor components. This focused rehabilitation improves muscle tone, enhances continence, and reduces the risk of prolapse recurrence.