No surgery for full-thickness rectal prolapse: what happens with continence?

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Physiology

Background:

• Surgery is the primary treatment for overt rectal prolapse, but nonoperative management is sometimes pursued.
• Limited data exists on the long-term functional outcomes of nonoperated rectal prolapse.
• This study investigates the natural history of rectal prolapse when surgery is deferred or avoided.

Purpose of the Study:

• To evaluate the functional outcomes and natural history of overt rectal prolapse in patients who did not undergo surgery.
• To compare the quality of life and symptom scores between operated and nonoperated rectal prolapse patients.
• To identify factors predicting functional deterioration in nonoperated rectal prolapse.

Main Methods:

• A prospective database of 206 patients with full-thickness rectal prolapse was established.
• Patients underwent anorectal manometry, endosonography, and evacuation proctography.
• Fecal incontinence (Cleveland Clinic Incontinence Score - CCIS) and constipation (Knowles Eccersley Scott Symptom Score - KESS) were assessed.

Main Results:

• Forty-two nonoperated patients were compared to age- and gender-matched operated patients over a mean follow-up of 44 months.
• Nonoperated patients reported similar symptoms but better quality of life initially; however, their CCIS and KESS scores showed no improvement.
• Sixteen nonoperated patients experienced worsening continence (average CCIS increase of 5 points), particularly those with mild incontinence (CCIS <7) or symptoms >4 years.

Conclusions:

• Nonoperative management of rectal prolapse offers no improvement in symptoms or continence.
• Patients with mild incontinence or long-standing rectal prolapse (>4 years) are unlikely to benefit from avoiding surgery.
• These findings support surgical intervention for overt rectal prolapse when feasible.