Diagnosis and Treatment of Anorectal Dysfunction Due to Organic Disease, Rectal Prolapse

Rectal prolapse refers to a condition in which the rectum descends and may protrude through the anus. It is classified as either complete rectal prolapse, where the full thickness of the rectum is externally visible, or occult prolapse (rectal intussusception), which remains within the anal canal. Multiple pathophysiological mechanisms have been proposed, including sliding hernia, intussusception progression, and pelvic floor dysfunction. Diagnosis is based on clinical examination and may require imaging studies such as defecography for occult cases. Differential diagnosis from hemorrhoids and identification of coexisting pelvic organ prolapse are essential in preoperative assessment. Surgical treatment is broadly categorized into perineal and abdominal approaches. Perineal techniques—such as the Gant-Miwa and Delorme procedures—are often chosen for elderly or high-risk patients due to their minimal invasiveness. Abdominal procedures, including laparoscopic or robot-assisted rectopexy, are associated with lower recurrence rates but require general anesthesia. Ventral rectopexy, in particular, preserves pelvic autonomic nerves and may reduce postoperative constipation. The choice of surgical approach should be individualized based on patient condition and institutional capabilities. Comprehensive evaluation, including assessment for coexisting pelvic organ prolapse, is crucial for successful management.