Rectal prolapse surgery

Overview

Rectal prolapse surgery is a procedure to repair rectal prolapse, which occurs when the last part of the large intestine (the rectum) stretches and protrudes from the anus. Surgery puts the rectum back in place.

There are a number of ways to do rectal prolapse surgery. Your surgeon will suggest the appropriate one for you based on your condition and your overall health.

Why it's done

Rectal prolapse surgery is performed in people troubled by chronic symptoms of rectal prolapse, such as leakage of stool, inability to control bowel movements (fecal incontinence) or obstructed bowel movements. The problem is most common in older women.

Risks

Rectal prolapse surgery carries serious risks. Risks vary, depending on surgical technique. But in general, rectal prolapse surgery risks include:

• Bleeding
• Bowel obstruction
• Damage to nearby structures, such as nerves and organs
• Narrowing (stricture) of the anal opening
• Infection
• Fistula — an abnormal connection between two body parts, such as the rectum and vagina
• Recurrence of rectal prolapse
• Development of new or worsened constipation

How you prepare

To prepare for rectal prolapse surgery, your doctor may ask that you:

• Clean with special soap. Before your surgery, you'll be asked to shower using antiseptic soap to help prevent germs on your skin from causing infection after your surgery.
• Stop taking certain medications. Depending on your procedure, you may be asked to stop taking certain medications.

You'll spend one or more days in the hospital after rectal prolapse surgery. So that you'll be as comfortable as possible during your stay, consider bringing:

• Personal care items, such as your toothbrush, hairbrush or shaving supplies
• Comfortable clothes, such as a robe and slippers
• Entertainment, such as books and games

What you can expect

During rectal prolapse surgery

Rectal prolapse surgery can be done through the abdomen (rectopexy) — either with a large incision (open surgery) or laparoscopic methods — or through the region around the anus (perineum).

The surgery might be done with general anesthesia, in which you're asleep; a spinal block, in which your lower half is numb; or a combination of relaxing medication and local anesthesia to numb your anus (perianal block).

Which approach your surgeon uses depends on a number of factors, such as your age, your other health problems, your surgeon's experience and preferences, and equipment available. No procedure is considered the best overall. Discuss your options with your surgeon.

Types of rectal prolapse surgery:

• Rectal prolapse repair through the abdomen. Using an incision in the abdomen, the surgeon pulls the rectum back in place. Using sutures or a mesh sling, he or she anchors the rectum to the back wall of the pelvis (sacrum). In some cases, such as a long history of constipation, the surgeon removes a portion of the colon.
• Laparoscopic rectal prolapse surgery. Also done through the abdomen, this procedure uses several smaller incisions. The surgeon inserts special surgical tools and a tiny camera through the abdominal incisions to repair the rectal prolapse. An emerging robotic approach uses a robot to perform the operation.

• Rectal prolapse repair through the area around the anus (perineal rectosigmoidectomy). During the more commonly performed form of this procedure (Altemeier procedure), the surgeon pulls the rectum through the anus, removes a portion of the rectum and sigmoid and attaches the remaining rectum to the large intestine (colon). This repair is typically reserved for those who are not candidates for open or laparoscopic repair.

  Another method for repairing a rectal prolapse through the perineum (Delorme procedure) is more typically done for short prolapses. The lining of the rectum is removed and the muscular layer folded to shorten the rectum.

If you have rectal prolapse and certain other conditions, such as vaginal prolapse or pelvic organ prolapse, you might have both repairs done in one surgery.

After rectal prolapse surgery

You'll spend a brief time in the hospital recovering and regaining your bowel function. You'll begin by drinking clear liquids and transition to solid foods. The amount of time you spend in the hospital, possibly just overnight, will depend on which procedure you have.

Your doctor is likely to recommend drinking lots of fluids, using stool softeners and eating a fiber-rich diet in the weeks after surgery to avoid constipation and excessive straining that can lead to recurrence of the rectal prolapse. Most people are able to return to normal activities within four to six weeks after surgery.

Some people require physical therapy to relearn how to use the pelvic floor muscles.

Results

For most people, rectal prolapse surgery relieves symptoms and improves fecal incontinence and constipation. However, in some cases, constipation can worsen or become a problem when it wasn't one before surgery. If you have constipation before surgery, talk to your doctor about ways to relieve it.

Recurrence of rectal prolapse after surgery occurs in about 2 to 5 percent of people. It appears to be slightly more common in people who have the perineal procedure compared with an abdominal one.