What criteria should I use to determine when to refer a patient with rectal prolapse to a specialist?

Criteria for referral of a patient with rectal prolapse to a specialist include:

• Presence of symptoms that significantly affect bowel function, continence, or quality of life, warranting specialist assessment and management.
• Failure of conservative or initial management approaches, such as pelvic floor muscle training or bowel retraining, indicating the need for specialist evaluation.
• Complex pelvic floor dysfunction or associated faecal incontinence that persists despite initial treatment, suggesting referral to a specialist continence service.
• Need for detailed specialist assessment including anorectal physiology studies, imaging (such as endoanal ultrasound or MRI), or other investigations to guide further management.
• Any suspicion of underlying pathology or complications that require exclusion by specialist examination.

Referral should be considered when the primary care assessment identifies these factors or when the patient requests specialist input after discussion of treatment preferences.

This approach aligns with recommendations for pelvic organ prolapse and faecal incontinence management, where referral is advised for complex cases, failed initial treatments, or when specialist diagnostic and therapeutic options are needed NICE NG123,NICE CG49.