Rectal prolapse surgery

Overview

Rectal prolapse surgery is a procedure to repair rectal prolapse. Rectal prolapse happens when the last part of the large intestine, called the rectum, stretches and slips out of the anus. Surgery puts the rectum back in place.

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

Why it's done

Rectal prolapse surgery can be done to relieve pain and discomfort. It also can treat symptoms that may accompany rectal prolapse, such as:

• Leakage of stool.
• Obstructed bowel movements.
• The inability to control bowel movements, called fecal incontinence.

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.
• Infection.
• Fistula — an irregular connection between two body parts, such as the rectum and vagina.
• Recurrence of rectal prolapse.
• Sexual dysfunction.
• 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 medicines. Depending on your procedure, you may be asked to stop taking certain medicines.

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

Before the procedure

Rectal prolapse surgery can be done through the abdomen, called rectopexy. Or surgery can be done through the area around the anus, called the perineum.

Which approach your surgeon uses depends on a number of factors, such as:

• The size of your prolapse.
• Your age.
• Whether you have 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.

Rectal prolapse surgery requires anesthesia. Some options include:

• General anesthesia, in which you're asleep.
• A spinal block, in which the lower half of your body is numb.

During the procedure

Types of rectal prolapse surgery:

• Rectal prolapse repair through the abdomen. Using a cut in the abdomen, the surgeon pulls the rectum back in place. Using sutures or a mesh sling, the surgeon anchors the rectum to the back wall of the pelvis, called the sacrum. For some people, such as those with a long history of constipation, the surgeon removes a portion of the colon.
• Laparoscopic rectal prolapse surgery. For this procedure, the surgeon makes several smaller cuts in the abdomen. Then the surgeon inserts special surgical tools and a tiny camera through the cuts to repair the rectal prolapse.
• Robotic surgery. This type of surgery is like the laparoscopic approach but uses the assistance of a surgical robot.

• Rectal prolapse repair through the area around the anus, called a perineal rectosigmoidectomy. The more commonly performed form of this repair is known as the Altemeier procedure. During this surgery, the surgeon pulls the rectum through the anus and removes the prolapsed portion of the rectum. The remaining portion of the rectum is then rejoined to the sigmoid colon. This repair is typically done for people who are not candidates for open or laparoscopic repair.

  Another method for repairing a rectal prolapse through the perineum is called the Delorme procedure. This procedure is more typically done for short prolapses. In this procedure, the surgeon removes the lining of the rectum and folds the muscular layer to shorten the rectum.

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

After the procedure

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

Your doctor is likely to recommend drinking lots of fluids, using stool softeners and eating a fiber-rich diet in the weeks after surgery. These are to avoid constipation and excessive straining that can cause the rectal prolapse to happen again. Most people can return to their normal activities within 4 to 6 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, for some people, 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% of people. It appears to be slightly more common in people who have the perineal procedure compared with an abdominal procedure.