management

Last reviewed 01/2018

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 fiber intake (20 to 35 g/day); taking fiber 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 fecal incontinence or constipation (1)

Reference:

• (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