Causes and classification
The causes of rectal prolapse are not clear. It is assumed that a weak fixation of the rectum in the pelvic area leads to prolapse. In addition, most patients with rectal prolapse can be diagnosed with chronic constipation or chronic diarrhea. Rectal prolapse is classified clinically as follows:
Grade I
Invisible, internal invagination (intussusception)
Grade II
Visible, external prolapse with spontaneous reduction
Grade III
Visible, external prolapse, manual reduction necessary
Grade IV
Reduction not possible
Treatment of an internal rectal prolapse
The surgical treatment of a first-degree rectal prolapse (internal rectal prolapse) depends on the symptoms and the severity of the prolapse. If rectal prolapse only occurs when pushing hard or straining, it is repaired using a minimally invasive stapling method (STARR surgery). This minimally invasive operation can also be performed for a small prolapse. As a rule, a two- to three-day inpatient hospital stay is advisable.
Treatment of an external rectal prolapse
Various minimally invasive procedures are also available for external rectal prolapse. The choice of surgical procedure depends on various factors, such as the patient’s general condition, age, concomitant diseases and incontinence status. Nutritional therapies to regulate bowel movements can also be considered. The standard operations for high-grade rectal prolapse are as follows:
- Operation via laparoscopy (laparoscopic resection rectopexy, with removal of part of the bowel),
- Operation via an abdominal incision (conventional resection rectopexy, without removal of part of the bowel),
- Operation via the anus according to Rehn-Delorme,
- Operation via the anus according to Atlemeier.
