Rectal Prolapse and Fecal Incontinence Management

Diagnostic Considerations

Excessive perineal descent is visible on imaging studies, which can help assess the severity of prolapse and associated fecal incontinence, as recommended by the American College of Radiology 1
MR defecography or conventional cystocolpoproctography (CCP) can help assess the severity of prolapse, anorectal angle changes, and presence of additional pelvic floor defects, according to the American College of Radiology 1, 2

Surgical correction of rectal prolapse is the primary treatment for associated fecal incontinence, with abdominal approaches showing superior outcomes, as stated by the American Gastroenterological Association 3, 4
Abdominal approaches, such as rectopexy with or without resection, have lower recurrence rates (0-8%) but higher morbidity, and laparoscopic approach has fewer complications and shorter hospital stay, according to the American Gastroenterological Association 3, 4
Perineal approaches are better suited for elderly patients or those with significant comorbidities, but have higher recurrence rates (5-21%), as noted by the American Gastroenterological Association 3, 4
Bowel resection during rectopexy should be avoided in patients with pre-existing diarrhea or incontinence, as these symptoms may worsen, as advised by the American Gastroenterological Association 3

Bowel management with stool softeners is recommended during recovery to prevent straining, as suggested by the American College of Gastroenterology 5