Severe fecal incontinence predicts higher recurrence risk in complete rectal prolapse: a retrospective cohort study

BACKGROUND: Postoperative recurrence poses a major challenge in the management of complete rectal prolapse (CRP). However, the association between fecal incontinence (FI) and recurrence risk remains unclear. In this study, we aimed to examine the relationship between FI severity and postoperative recurrence in patients with CRP. METHODS: Patients with CRP who underwent surgical treatment at Guang’anmen Hospital, China Academy of Traditional Chinese Medicine, between January 1, 2013, and August 31, 2025, were enrolled. Multivariate survival analysis was conducted to investigate the relationship between FI and postoperative recurrence of rectal prolapse. A restricted cubic spline regression was used to assess the linearity of this relationship. RESULTS: Among 211 patients with CRP, including 50 with severe FI, FI was significantly associated with postoperative recurrence risk after adjusting for covariates in multivariate survival analysis (P < 0.05). Compared with the baseline group (FI score ≤ 5), the risk of recurrence was 6 times higher in patients with FI scores ≥ 16 (unadjusted model: HR = 5.57 [2.29–13.53]; model 1: HR = 4.49 [1.86–10.88]; model 2: HR = 6.06 [2.38–15.39]; P < 0.05). FI showed a linear and positive correlation with recurrence risk (P for nonlinearity > 0.05). Survival curves demonstrated significant differences in recurrence-free survival among FI subgroups, with a sharp decrease in survival probability at scores ≥ 16, indicating the highest risk of recurrence. CONCLUSION: FI is an important predictor of postoperative recurrence in rectal prolapse, with severe FI serving as an independent high-risk factor. The severity of FI provides an evidence-based foundation for optimizing surgical protocols, stratifying postoperative management, and preventing recurrence.