History of the Treatment of Rectal Prolapse

Rectal prolapse is the intussusception of the rectum, resulting in its full-thickness protrusion out of the anus. Approximately 0.5% of the general population is affected by this condition, with a higher occurrence in women and the elderly. While benign, rectal prolapse can be debilitating, as it can cause pain, bleeding, mucus discharge, and fecal incontinence. The earliest documented records of rectal prolapse date back to Ancient Egypt (1500-1200 BC), describing laxatives and topical therapeutics for the treatment of an anus turned inside out. Many techniques were devised to hold the reduced prolapsed rectum in place, ranging from cords to the use of bandages. Surgical cauterization of the anal sphincter to prevent recurrent prolapse began as early as 6 BC in India, a practice that continued into the 1800s. Advances in fundamental understanding of the anatomy of the colon, rectum, and anus in the 19th and early 20th centuries paved the way for modern surgical approaches. The 20th century saw the development of procedures proposed by surgeons such as Delorme, Moschowitz, Ripstein, and Altemeier. The emergence of the laparoscopic rectopexy in 1992 and subsequent use of robotic-assisted techniques in the early 2000s marked the transition to modern rectal prolapse surgeries, improving both precision and outcomes. The overall management of rectal prolapse has evolved significantly from ancient remedies to the surgeries known today, yet some fundamental similarities remain consistent between today's outlook and what was documented centuries ago. Understanding the historical evolution of the diagnosis and treatment of rectal prolapse provides insight into the contemporary management of the disorder.