Tailored treatments in internal rectal prolapse

Background: Internal rectal prolapse is commonly reported in patients suffering pelvic floor disorders, such as obstructive defecation and incontince. Unfortunately, its treatment not always offers a symptoms resolution. Material and methods: To investigate the correct management and its influence in symptoms resolution, we investigated patients submitted to hierarchic therapeutic options from conservative to surgical treatments. An evaluation of the appropriate treatment tailored on the entity of the prolapse was proposed. Results: We investigated 84 patients [64 F, 20 M (median age 52)]. In 44 a symptoms resolution was obtained with medical therapy. To 40 patients biofeedback rehabilitation was offered and 18 of them improved. 22 were treated with a surgical approach that ranged from mucosal plication or mucopexy to transanal rectal resection according to the prolapse entity. Functional improvement was obtained in 21 patients regarding obstructive defecation syndrome while incontinence related symptoms were not statistically changed. We reported a serious complication in a patient treated with transanal rectal resection that suffered a fatal sepsis in the post-operative course. Discussion: The optimal management for internal rectal prolapse is still discussed. No one technique showed a superiority over the others. Pelvic floor retraining may be useful in patients with defecation disorders not associated with a high grade internal rectal prolapse. Mucosal plication can offer a safe role in the treatment of this anatomical disorder that is not always offers a symptoms resolution.