Reduction
Depending on the type of prolapse and the viability, different approaches to treatment can be taken. In simple prolapses with viable tissue, reduction can be used to place the prolapsed section back into its anatomical position. Before reduction can begin, the prolapse needs to be cleaned and moistened using warm saline solution; a hypertonic sugar solution of 30% dextrose or 70% mannitol can be applied topically to reduce oedema. In cases of persistent straining, an epidural may be administered.
There are no special considerations regarding anaesthesia for this procedure, the overall health of the patient should be monitored and an anaesthesia protocol should be made accordingly.
The prolapse should be lubricated well using a water based gel. Using either a finger or a bougie, the prolapsed section can be manually reduced back. A purse-string suture should be placed around the anus for five to seven days to prevent recurrence. The suture should be loose enough for fecal matter to pass, but sufficient to prevent recurrence of the prolapse during its placement. Post-surgery stool softeners and a moist diet are recommended to allow easy passage of feces and to reduce the risk of straining and recurrence.
In cases which the rectal tissue is viable but not reducible, a laparotomy with colopexy is indicated to keep the rectum in place and prevent a recurrence.
Resection
In severe cases which the prolapsed tissue has become necrotic, lacerated, or irreducible, a rectal resection should be performed to remove the damaged tissue and to anastomose the remaining rectum or colon with the anus. The prolapse should be thoroughly washed with isotonic saline solution and the area around the anus should be washed with chlorhexidine or povidone-iodine prior to surgery.
The dorsal 180º should be transected through both rectal walls, any blood vessels should be clamped or ligated accordingly. The two adjacent walls of the rectum are sutured together (leaving two long stay sutures) before the lower 180º is transected and sutured back together, clamping and ligating any blood vessels as required. Once the mass is removed, a layer of simple interrupted sutures are placed around the circumference of the rectum before the stay sutures are cut and the rectum returns to its new position.