There is still uncertainty about the exact pathogenesis and etiology of rectal prolapse: Is it a sliding hernia, an intussusception, or a combination of both mechanisms? In varying degrees, the following anatomical-functional changes are found in this disease:
- an abnormally deep Douglas pouch (3, 13, 19)
- a diastasis of the levator musculature
- a functional weakness of the internal and external anal sphincters (3, 13)
- a weak pelvic floor musculature
- a pudendal neuropathy (13, 19)
- a mobile mesorectum with insufficient dorsal and lateral fixation of the rectum (13, 19, 29)
- an elongated, redundant sigmoid (13,19,29).
Which of the changes favor a rectal prolapse and which are secondary consequences is ultimately unclear and can hardly be clarified within the framework of diagnostics.
Treatment goals are the elimination of the prolapse and the restoration of defecation and continence behavior. Therapy options available (13, 19, 29):
- Fixation of the rectum to the sacrum
- Resection or plication of the redundant bowel.
Thereby, a distinction is made between transabdominal and local procedures.