Vitamin B1 and C deficiencies in patients presenting with rectal prolapse

Vitamin C and thiamine deficiency are considered rare conditions in industrialized countries. Due to poor dietary choices or lack of access to nutritional food, or because of an association with some underlying disorders, such deficiencies may be observed in subsets of patients. These deficiencies may have detrimental effects on the outcome of surgery.

All consecutive patients presenting with rectal prolapse to the authors’ outpatient clinic between January 2021 and October 2023 underwent vitamin C and thiamine level testing. In addition, thyroid-stimulating hormone (TSH), prealbumin, and zinc levels were determined.

Ten women and one man (median age 68.3 years, range 45.6–90.5) were identified. Median body mass index was 23.3 kg/m² (range 15.8–35). Prealbumin, zinc, and TSH levels were within the normal range in all cases. Only 3 patients (27%) were neither vitamin C nor B1 deficient, whereas 45% were either vitamin C or B1 deficient. None of the patients had clinical signs of scurvy, Wernicke encephalopathy, or beriberi; however, neuropathy and chronic constipation were common clinical symptoms. Once deficiencies had been identified, patients were started on supplementation and nutritional counseling was administered. Patients retested within 3–6 months showed normal vitamin C and B1 levels. Nine patients underwent laparoscopic/robotic modified Wells rectopexy, one was medically unfit for surgery, and one female patient with a gastric bypass dramatically improved after vitamin supplementation and pelvic floor training.

The significance of the findings is not completely clear but warrants further investigation, as vitamin C is critical for wound healing and thiamine deficiency is implicated in gut beriberi, contributing to constipation as well as neuropathic pelvic floor dysfunction.