Standardized Criteria and Management Strategies for Internal Rectal Prolapse in the Context of Pelvic Floor Dysfunction

doi:10.12280/gjfckx.20251137

Abstract

Abstract:

Pelvic floor dysfunction (PFD) is a clinical syndrome mainly characterized by urinary incontinence, defecation dysfunction, and pelvic organ prolapse, which significantly affects the quality of patients' life. Internal rectal prolapse (IRP), as an important component of PFD, is closely related to the integrity of the pelvic floor support structure in terms of its grading. Current evidence shows that the degeneration of the pelvic floor support structures and the dysfunction of the levator ani muscle caused by PFD are the key driving factors for the occurrence and development of IRP. The grading of IRP is significantly correlated with the degree of pelvic floor injury. High-grade IRP (Grades Ⅲ-Ⅳ) is often accompanied by severe pelvic floor anatomical and functional abnormalities. Dynamic magnetic resonance defecography (DMRD) and high-resolution anorectal manometry (HR-ARM) are the key tools for objective grading and functional evaluation. In terms of treatment, low-grade IRP responds well to pelvic floor muscle training (PFMT), while high-grade IRP often requires surgical intervention. Currently, there is still a lack of a unified grading standard and support from prospective cohort studies in this field. In the future, efforts should be made to construct a standardized grading system through multi-center collaboration, integrating radiomics and artificial intelligence technologies to promote precision diagnosis and treatment.

Key words: Pelvic floor disorders, Prolapse of rectum, Diagnosis, Standardized criteria, Pelvic floor muscle training

LIU Fei-hu, GUAN Zhong-an. Standardized Criteria and Management Strategies for Internal Rectal Prolapse in the Context of Pelvic Floor Dysfunction[J]. Journal of International Obstetrics and Gynecology, 2026, 53(1): 48-53.

Figures/Tables 1

References 30

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分级	影像学特征	临床表现
Ⅰ级	直肠黏膜轻度、局灶性内陷（深度<3 mm），肠壁肌层完整。	通常无临床意义，常见于无症状人群或偶发排便不畅。
Ⅱ级	黏膜环周性脱垂或套叠（套叠深度≥3 mm），但仅限于黏膜层，未延伸至肌层。	可出现明显的临床症状，如排便梗阻感、肛门坠胀等。
Ⅲ级	直肠全层壁套叠，进入肛管上段。	症状严重且典型，与IRP的相关性极高。强烈的排便梗阻感，常需手法辅助。
Ⅳ级	套叠的直肠壁持续下降，可达肛管下段或肛门外缘（需与外部脱垂鉴别）	最严重的表现形式，症状极其严重，几乎必然发展为完全性直肠脱垂，必须进行临床干预。

分级	影像学特征	临床表现
Ⅰ级	直肠黏膜轻度、局灶性内陷（深度<3 mm），肠壁肌层完整。	通常无临床意义，常见于无症状人群或偶发排便不畅。
Ⅱ级	黏膜环周性脱垂或套叠（套叠深度≥3 mm），但仅限于黏膜层，未延伸至肌层。	可出现明显的临床症状，如排便梗阻感、肛门坠胀等。
Ⅲ级	直肠全层壁套叠，进入肛管上段。	症状严重且典型，与IRP的相关性极高。强烈的排便梗阻感，常需手法辅助。
Ⅳ级	套叠的直肠壁持续下降，可达肛管下段或肛门外缘（需与外部脱垂鉴别）	最严重的表现形式，症状极其严重，几乎必然发展为完全性直肠脱垂，必须进行临床干预。