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Distinct Phenotypes of Full-Thickness Rectal Prolapse in Women: A Comparison of Defecation-Only and Spontaneous Presentations.

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Title: Distinct Phenotypes of Full-Thickness Rectal Prolapse in Women: A Comparison of Defecation-Only and Spontaneous Presentations.
Authors: Zhou Z; Department of Surgery, Stanford University School of Medicine, Stanford, California, USA., Earley M; Department of Surgery, Stanford University School of Medicine, Stanford, California, USA., Hoy SA; Department of Surgery, Stanford University School of Medicine, Stanford, California, USA., Sheth VR; Department of Radiology, Stanford University School of Medicine, Stanford, California, USA., Gurland B; Department of Surgery, Stanford University School of Medicine, Stanford, California, USA., Neshatian L; Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Source: Neurogastroenterology and motility [Neurogastroenterol Motil] 2026 Feb; Vol. 38 (2), pp. e70265.
Publication Type: Journal Article; Comparative Study
Language: English
Journal Info: Publisher: Blackwell Scientific Publications Country of Publication: England NLM ID: 9432572 Publication Model: Print Cited Medium: Internet ISSN: 1365-2982 (Electronic) Linking ISSN: 13501925 NLM ISO Abbreviation: Neurogastroenterol Motil Subsets: MEDLINE
Imprint Name(s): Original Publication: Osney Mead, Oxford, UK : Blackwell Scientific Publications, c1994-
MeSH Terms: Rectal Prolapse*/physiopathology , Rectal Prolapse*/diagnostic imaging , Defecation*/physiology, Anal Canal/physiopathology ; Rectum/physiopathology ; Humans ; Female ; Phenotype ; Manometry ; Retrospective Studies ; Defecography ; Middle Aged ; Aged ; Magnetic Resonance Imaging
Abstract: Background: While some patients report full thickness rectal prolapse (RP) exclusively during defecation, others may experience it spontaneously during walking, exercise, and/or all the time. We hypothesized that patients with RP only during defecation have more preserved physiological and anatomical characteristics and aimed to identify the phenotypes of patients with various RP expression.
Methods: A retrospective analysis of a prospectively maintained registry of women with RP (2017-2023) included clinical characteristics, MRI defecography (MRD), and high-resolution anorectal manometry (HR-ARM).
Key Results: Of 297 patients, 147 (49%) experienced defecation-only RP, while 150 (51%) had spontaneous RP. The defecation-only RP group was younger (p < 0.001) and exhibited higher obstructive defecation syndrome (ODS) scores (p < 0.001), associated with higher rectal pressures at simulated defecation. The spontaneous RP patients had higher Wexner fecal incontinence scores (p < 0.001) and were more likely to seek medical care within 6 months of symptom onset (p = 0.006). On MRD, they had larger levator hiatus length, width, and bowl volume along with a wider anorectal angle. HR-ARM showed lower resting anal pressures (p = 0.03) and less sustained squeeze pressures (p = 0.04) in this group.
Conclusions and Inferences: Defecation-only RP appears to represent a distinct phenotype, potentially an early stage of RP, characterized by younger age, more severe obstructive symptoms, more preserved anal sphincter function, and less pelvic floor laxity. Future research should focus on risk factors for progression to more sustained RP and the potential benefits of early intervention in patients with defecation-only RP.
(© 2026 John Wiley & Sons Ltd.)
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Contributed Indexing: Keywords: MR defecography; anal sphincter; anorectal manometry; full thickness rectal prolapse; levator hiatus
Entry Date(s): Date Created: 20260218 Date Completed: 20260708 Latest Revision: 20260708
Update Code: 20260708
DOI: 10.1111/nmo.70265
PMID: 41708524
Database: MEDLINE
Description
ISSN:1365-2982
DOI:10.1111/nmo.70265