title: Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies.
abstract: Rectal prolapse can present in a variety of forms and is associated with a range of symptoms including pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipation. Complete external rectal prolapse is characterized by a circumferential, full-thickness protrusion of the rectum through the anus, which may be intermittent or may be incarcerated and poses a risk of strangulation. There are multiple surgical options to treat rectal prolapse, and thus care should be taken to understand each patient's symptoms, bowel habits, anatomy, and pre-operative expectations. Preoperative workup includes physical exam, colonoscopy, anoscopy, and, in some patients, anal manometry and defecography. With this information, a tailored surgical approach (abdominal versus perineal, minimally invasive versus open) and technique (posterior versus ventral rectopexy +/- sigmoidectomy, for example) can then be chosen. We propose an algorithm based on available outcomes data in the literature, an understanding of anorectal physiology, and expert opinion that can serve as a guide to determining the rectal prolapse operation that will achieve the best possible postoperative outcomes for individual patients.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, ACC 460, Boston, MA, 02114, USA, lbordeianou@partners.org.
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
authors.forename: Caitlin W
authors.initials: CW
authors.lastname: Hicks
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Kaiser
authors.forename: Karim
authors.initials: K
authors.lastname: Alavi
authors.forename: Ranjan
authors.initials: R
authors.lastname: Sudan
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wise
mesh_terms: D000465:Algorithms; D006801:Humans; D010535:Laparoscopy; D017773:Pelvic Floor / Q000033:anatomy & histology; D012005:Rectal Prolapse / Q000175:diagnosis* / Q000601:surgery* / Q000628:therapy