The precise pathogenesis and etiology of rectal prolapse is still under discussion: Is it a sliding hernia, an intussusception or a combination of both mechanisms? This clinical entity is characterized by the following functional anatomical pathologies which are present in varying degrees:
- Atypically low Douglas pouch (3, 13, 19)
- Levator ani muscle diastasis
- Functional weakness of the external and internal anal sphincter (3, 13)
- Weak pelvic floor musculature
- Pudendal neuropathy (13, 19)
- Mobile mesorectum with insufficient posterior and lateral fixation of the rectum (13, 19, 29)
- Elongated redundant sigma (13,19,29).
Ultimately, it is unclear which of the changes favor rectal prolapse and which are sequelae, and this is almost impossible to clarify in diagnostic work-up.
The treatment aims to remedy the prolapse and restore defecation and continence. The following treatment options are available (13, 19, 29):
- Fixation of the rectum to the sacrum
- Resection or plication of the redundant bowel.
A distinction is made between intraabdominal and local procedures.