Rectal prolapse is a medical condition where the walls of the rectum, the final section of the large intestine, slide out of place and protrude through the anus. This occurs due to the weakening of the pelvic floor muscles and ligaments that normally hold the rectum in its proper position. Because the condition does not resolve on its own and tends to worsen over time, it requires specialized medical intervention. Understanding which medical professionals are best equipped to diagnose and treat this issue is the first step toward effective management and recovery.
Identifying the Specialists for Rectal Prolapse
The definitive medical expert for treating rectal prolapse is a Colorectal Surgeon. This physician has completed advanced training in the surgical and non-surgical treatment of diseases of the colon, rectum, and anus. This specialist is sometimes referred to as a Proctologist, a term that broadly covers disorders of the anus and rectum. Their specialized knowledge is necessary for accurate diagnosis and the complex surgical repair the condition usually requires.
A Colorectal Surgeon performs the delicate procedures that anchor the rectum back into its correct anatomical position. They are trained to assess the full extent of pelvic floor dysfunction, which often accompanies rectal prolapse. This comprehensive understanding ensures that treatment is tailored to the prolapse and any related issues like fecal incontinence.
A patient may initially consult with a Gastroenterologist, who specializes in digestive system disorders, for an initial evaluation. A General Surgeon may also be involved in initial care, but they will often refer the patient to a Colorectal Surgeon for specialized reconstructive surgery. The best long-term outcomes are achieved when a board-certified Colorectal Surgeon leads the treatment plan.
How Rectal Prolapse is Diagnosed
Diagnosis begins with a thorough physical examination performed by the specialist. The physician inspects the anal area and may perform a digital rectal exam to assess the strength of the anal sphincter muscles. A common part of the examination involves the “straining test,” where the patient is asked to sit on a commode and bear down as if having a bowel movement.
This straining reproduces the prolapse, allowing the physician to visually confirm the condition. They determine if it is a full-thickness prolapse of the entire rectal wall or a mucosal prolapse involving only the inner lining. Confirming the prolapse visually is the most direct way to differentiate it from other conditions.
The specialist may order specialized tests to evaluate pelvic floor function. Defecography, performed using X-ray or Magnetic Resonance Imaging (MRI), is a dynamic study that captures images of the rectum and pelvic muscles while the patient is actively defecating. This test is useful for identifying the extent of the prolapse and detecting associated pelvic floor disorders that may influence the surgical approach.
Anorectal manometry measures the pressure and coordination of the muscles in the rectum and anal canal. This test assesses the strength of the anal sphincter, which is often weakened in patients with rectal prolapse, helping the surgeon plan for continence improvements after the repair. A colonoscopy may also be performed to rule out other underlying conditions, such as polyps or colon cancer, which can mimic prolapse symptoms.
Surgical and Non-Surgical Treatment Pathways
Treatment for rectal prolapse is primarily surgical, as an operation is the only way to provide a lasting repair. Non-surgical management, which includes dietary adjustments and stool softeners, is generally reserved for managing constipation and is often incorporated into post-operative care. Non-surgical approaches are typically only considered for patients whose significant health issues make them unsuitable candidates for surgery.
The surgical strategy is customized based on the patient’s age, overall health, and the severity of the prolapse. Repairs are broadly categorized into two main approaches: abdominal and perineal. Abdominal approaches, such as a rectopexy, are favored for younger, healthier patients because they offer the lowest risk of recurrence.
A rectopexy involves mobilizing the rectum and securing it to the sacrum, the bone at the back of the pelvis, often using sutures or a synthetic mesh. This procedure can be performed through traditional open surgery or a less invasive laparoscopic or robotic technique, which facilitates a faster recovery. While abdominal repairs have a high success rate, some patients may experience new or worsening constipation afterward.
Perineal approaches are performed through the area around the anus and are less invasive than abdominal surgery, making them a better choice for elderly patients or those with multiple medical conditions. The two most common perineal procedures are the Altemeier procedure and the Delorme procedure.
The Altemeier procedure involves excising the full thickness of the prolapsed rectum and sewing the two ends of the bowel together. The Delorme procedure is a less extensive option where the surgeon removes only the prolapsed inner mucosal lining and folds the remaining rectal muscle wall onto itself to shorten and stabilize the rectum. Perineal repairs are associated with a quicker recovery but can carry a higher rate of recurrence compared to abdominal procedures. The specialist weighs these factors to select the procedure that offers the best balance of safety and long-term effectiveness.