Management

The elderly patient will either conceal a rectal prolapse, or tolerate it remarkably. In most instances, an acute prolapse will reduce spontaneously while some patients become accustomed to pushing back the prolapse after defecation and rarely complain about their condition (1) .

Conservative management

• evidence for their efficacy is lacking.
• may be useful
  • as an adjunct to surgery for full-thickness by softening the stool and improving defecation
  • in patients with symptomatic intussusception
• following management options can be used in patients who are poor operative candidates or choose to avoid an operative approach:
  • application of ice wrapped in a cloth or sugar to the prolapsed rectum to reduce the oedema and facilitate manual reduction of the prolapse
  • increasing fibre intake (20 to 35 g/day); taking fibre supplements; and using stool softeners to reduce constipation, minimize straining, and heal rectal ulcers.
  • other forms of conservative management include perineal exercises (1,2,3)

Surgical management

• is the strategy of choice in majority of symptomatic patients with rectal prolapse e.g. - majority of cases of external prolapses or when the internal prolapse/intussusception becomes symptomatic.
• goals of rectal prolapse surgery are
  • to correct the prolapse
  • to alleviate pre-operative complaints of discomfort
  • to ameliorate or cure faecal incontinence or constipation (1)

Abdominal procedures are usually indicated for young fit patients, whereas perineal approaches are often preferred in older frail patients with significant comorbidity (4)

Laparoscopic procedures have the advantages of less pain, early recovery, and lower morbidity and are an effective tool for the treatment of rectal prolapse. (4) They have shown outcomes as good as for open procedures. (5)

References:

1. Bordeianou L et al. Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. J Gastrointest Surg. 2014;18(5):1059-69.
2. Jones OM, Cunningham C, Lindsey I. The assessment and management of rectal prolapse, rectal intussusception, rectocoele, and enterocoele in adults. BMJ. 2011;342:c7099.
3. American Academy of Family physicians (AAFP). FP Comprehensive 2016 - Board Preparation. Anorectal conditions. Rectal prolapse
4. Tsunoda A. Surgical Treatment of Rectal Prolapse in the Laparoscopic Era; A Review of the Literature. J Anus Rectum Colon. 2020 Jul 30;4(3)
5. Sajid MS et al. Open vs laparoscopic repair of full-thickness rectal prolapse: a re-meta-analysis. Colorectal Dis. 2010 Jun;12(6):515-25