Rectal Prolapse in Older Women

Anatomical Pathophysiology

Pelvic floor muscle weakness and denervation injury increase stress on the fascia and lead to progressive weakening of support structures, particularly in women over 60 who have undergone menopause and vaginal multiparity 1
Chronic increases in intra-abdominal pressure from repetitive straining during defecation cause mechanical stretching and eventual failure of the rectovaginal septum, levator ani muscles, and endopelvic fascia 1

Concurrent pelvic organ prolapse is common, including cystocele, enterocele, uterovaginal prolapse, and bladder prolapse, reflecting global pelvic floor failure, as noted by the American College of Radiology 2
Anal sphincter damage develops from mechanical stretching over time as the prolapsed rectum repeatedly passes through the anal canal, explaining why fecal incontinence is the predominant symptom 3

Dynamic cystocolpoproctography (CCP) demonstrates the functional anatomy during defecation in physiologic upright positioning, with 88% sensitivity for detecting internal rectal prolapse and excellent visualization of full-thickness prolapse, rectoceles, and peritoneoceles, as recommended by the American College of Radiology 2
Contrast-enhanced CT of abdomen and pelvis should be performed in complicated cases to detect bowel obstruction, perforation, prolapse of other pelvic organs, and to rule out colorectal malignancy, which has a 4.2-fold increased relative risk in patients with rectal prolapse, according to the World Journal of Emergency Surgery 4

The presence of rectal prolapse mandates colorectal cancer screening, as rectosigmoid cancer prevalence is 5.7% in patients with rectal prolapse compared to 1.4% in age-matched controls, representing a significantly elevated risk that should not be overlooked, as noted by the World Journal of Emergency Surgery 4