EPD500 - Management of Internal Rectal Prolapse: Expert Consensus Recommendation from the Pelvic Floor Disorders Consortium

Author(s)

• 

  Amy J. Thorsen, MD (she/her/hers)

  Associate Professor of Surgery
  University of Minnesota
  Hopkins, Minnesota, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• 

  Brooke Gurland, MD, FASCRS, FACS

  Clinical Professor of Surgery
  Stanford University
  Stanford Surgery
  MENLO PARK, CA, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• 

  Liliana Bordeianou, MD, MPHFASCRS

  Professor of Surgery
  Harvard Medical School; Mass General Brigham Division Colon and Rectal Surgery
  Harvard
  Boston, MA, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
• 

  Abhijit Chandra, MD, MCh (he/him/his)

  Head of the Department, Surgical Gastroenterology
  King George's Medical University
  King George Medical University,Lucknow, India
  Lucknow, Uttar Pradesh, India

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• LN

  Leila Neshatian, MD, Msc

  Clinical Associate Professor
  Stanford University
  Redwood City, California, United States

  Disclosure information not submitted.
• PB

  Pedro C. Basilio, FACS, FASCRS, TSBCP

  Senior Colorectal Surgeon
  Hospital Copa Star
  Rio de Janeiro, Rio de Janeiro, Brazil

  Disclosure information not submitted.
• 

  Lucia C C Oliveira, MD,PhD (she/her/hers)

  Director
  Anorectal Physiology Department of Rio de Janeiro
  Casa de Saude Sao Jose
  Rio de Janeiro, Rio de Janeiro, Brazil

  Disclosure information not submitted.
• MW

  Milena M. Weinstein, MD

  Professor
  Massachusetts General Hospital
  Boston, Massachusetts, United States

  Disclosure information not submitted.
• 

  Anne-Marie Sirany, MD

  Adjunct Faculty
  University of Minnesota, Division of Colon and Rectal Surgery, MN, United States

  Disclosure information not submitted.

ePoster of Distinction Presenter(s)

• 

  Craig H. Olson, MD

  Colorectal Surgeon
  Baylor Scott and White Waxahachie
  Texas A&M Medical School
  Waxahachie, Texas, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

Purpose/Background: Internal Rectal Prolapse (IRP), also known as rectal intussusception, is a common condition associated with fecal incontinence and obstructive defecation (FIOD). Despite its prevalence, there is limited literature is available to guide the surgeon in management of IRP. Existing studies are few in number, often heterogeneous, and lack consistent outcome measures. To address these gaps, the Pelvic Floor Disorders Consortium (PFDC) sought to establish expert consensus on the management of IRP.

Methods/Interventions: Surgeon members of the PFDC, an international group dedicated to pelvic floor disorders, participated in the development of expert recommendations. Multidisciplinary workgroups-including colorectal surgeons, urogynecologists, gastroenterologists, and physiotherapists-conducted literature reviews and developed draft statements over 3-6 virtual meetings. These statements were presented to the PRDC membership at the national meeting in San Diego, May 2025. Statements achieving >70% agreement were included in the final consensus.

Results/Outcomes: Nine consensus statements met the threshold of >70% agreement and were organized into four categories: Definitions and Grading, Diagnosis and Workup of Fecal Incontinence and Obstructive Defecation (FIOD), Medical Management, and Surgical Management (Table 1).

Conclusion/Discussion: The group cautiously supported operative correction of symptomatic high grade IRP (Oxford grades III and IV), but stressed the importance of careful patient selection. Candidates should demonstrate FIOD symptoms, assessed using validated patient-reported outcome instruments, or present with associated conditions such as solitary rectal ulcer or non-emptying rectocele. A diagnosis of high-grade IRP should be confirmed with dynamic imaging. In addition, all patients should undergo multidisciplinary team evaluation and have documented trials of medical management, lifestyle modification, and pelvic floor physical therapy prior to operative intervention. The consortium emphasized that surgery for IRP with the primary goal of pain relief alone is not recommended and should be discouraged.

Statements
Intenral Rectal Prolapse Mangement Statements by Category