Management of Rectal Prolapse in Elderly Women

Primary Specialist: Colorectal Surgeon

The American College of Surgeons recommends that colorectal surgeons are the definitive specialists for managing rectal prolapse, as they perform both transabdominal and perineal surgical approaches for definitive repair 1
Patients with rectal prolapse have a 4.2-fold increased risk of colorectal cancer, with a prevalence of 5.7% compared to 1.4% in age-matched controls, highlighting the need for preoperative endoscopic screening by colorectal surgeons 1, 3
The condition requires surgical expertise in rectal anatomy, pelvic floor reconstruction, and management of associated complications, including fecal incontinence, which is a critical aspect of care provided by colorectal surgeons 2, 3

The American College of Radiology suggests that urogynecology consultation is appropriate when concurrent pelvic organ prolapse is documented, as rectal prolapse frequently coexists with other pelvic floor defects 4, 3
In elderly women, rectal prolapse commonly presents with other pelvic floor support defects, such as cystocele, enterocele, uterovaginal prolapse, or bladder prolapse, reflecting global pelvic floor failure 3

Radiologists specializing in pelvic floor imaging may be consulted for dynamic cystocolpoproctography (CCP), which has 88% sensitivity for detecting internal rectal prolapse and excellent visualization of multi-compartment prolapse 4, 3
Contrast-enhanced CT should be performed to rule out colorectal malignancy, bowel obstruction, or perforation in complicated cases, as recommended by the World Journal of Emergency Surgery 1, 3

Failing to screen for colorectal cancer is a major oversight, as flexible sigmoidoscopy or colonoscopy should be routinely performed in all patients with symptomatic rectal prolapse, according to the World Journal of Emergency Surgery 1