Rectal prolapse repair surgery treats a condition in which the rectum falls, or prolapses, from its normal anatomical position because of a weakening in the surrounding supporting tissues.
A prolapse occurs when an organ falls or sinks out of its normal anatomical place. The pelvic organs normally have tissue (muscle, ligaments, etc.) holding them in place. Certain factors, however, may cause those tissues to weaken, leading to prolapse of the organs. The rectum is the last out of six divisions of the large intestine; the anus is the opening from the rectum through which stool exits the body. A complete rectal prolapse occurs when the rectum protrudes through the anus. If rectal prolapse is present, but the rectum does not protrude through the anus, it is called occult rectal prolapse, or rectal intussusception. In females, a rectocele occurs when the rectum protrudes into the posterior (back) wall of the vagina.
Factors that are linked to the development of rectal prolapse include age, repeated childbirth, constipation, ongoing physical activity, heavy lifting, prolapse of other pelvic organs, and prior hysterectomy . Symptoms of rectal prolapse include protrusion of the rectum during and after defecation, fecal incontinence (inadvertent leakage of feces with physical activity), constipation, and rectal bleeding. Women may experience a vaginal bulge, vaginal pressure or pain, painful sexual intercourse, and lower back pain.
The overall incidence of rectal prolapse in the United States is approximately 4.2 per 1,000 people. The incidence of the disorder increases to 10 per 1,000 among patients older than 65. Most patients with rectal prolapse are women; the ratio of male-to-female patients is one in six.
Surgery is generally not performed unless the symptoms of the prolapse have begun to interfere with daily life. Because of the numerous defects that can cause rectal prolapse, there are more than 50 operations that may be used to treat the condition. A perineal or abdominal approach may be used. While abdominal surgery is associated with a higher rate of complications and a longer recovery time, the results are generally longer lasting. Perineal surgery is generally used for older patients who are unlikely to tolerate the abdominal procedure well.
Rectopexy and anterior resection are the two most common abdominal surgeries used to treat rectal prolapse. The patient is usually placed under general anesthesia for the duration of surgery. During rectopexy, an incision into the abdomen is made, the rectum isolated from surrounding tissues, and the sides of the rectum lifted and fixed to the sacrum (lower backbone) with stitches or with a non-absorbable mesh. Anterior resection removes the S-shaped sigmoid colon (the portion of the large intestine just before the rectum); the two cut ends are then reattached. This straightens the lower portion of the colon and makes it easier for stool to pass. Rectopexy and anterior resection may also be performed in combination and may lead to a lower rate of prolapse recurrence.
As an alternative to the traditional laparotomy (large incision into the abdomen), laparoscopic surgery may be performed. Laparoscopy is a surgical procedure in which a laparoscope (a thin, lighted tube) and various instruments are inserted into the abdomen through small incisions. Rectopexy and anterior resection have been performed laparoscopically with good results. A patient's recovery time following laparoscopic surgery is shorter and less painful than following traditional abdominal surgery.
Perineal repair of rectal prolapse involves a surgical approach around the anus and perineum. The patient may be placed under general or regional anesthesia for the duration of surgery.
The most common perineal repair procedures are the Altemeier and Delorme procedures. During the Altemeier procedure (also called a proctosigmoidectomy), the prolapsed portion of the rectum is resected (removed) and the cut ends reattached. The weakened structures supporting the rectum may be stitched into their anatomical position. The Delorme procedure involves the resection of only the mucosa (inner lining) of the prolapsed rectum. The exposed muscular layer is then folded and stitched up and the cut edges of mucosa stitched together.
A rarely used procedure is anal encirclement. Also called the Thiersch procedure, anal encirclement involves the insertion of a thin circular band of non-absorbable material under the skin of the anus. This narrows the anal opening and prevents the protrusion of the rectum through the opening. This procedure, however, does not address the underlying condition and therefore is generally reserved for patients who are not good candidates for more invasive surgery.
Physical examination is most often used to diagnose rectal prolapse. The patient is asked to strain as if defecating; this increase in intra-abdominal pressure will maximize the degree of prolapse and aid in diagnosis. In some instances, imaging studies such as defecography (x rays taken during the process of defecation) may be administered to determine the extent of prolapse.
Before surgery, an intravenous (IV) line is placed so that fluid and/or medications may be easily administered to the patient. A Foley catheter will be placed to drain urine. Antibiotics are usually given to help prevent infection. The patient will be given a bowel prep to cleanse the colon and prepare it for surgery.
A Foley catheter may remain for one to two days after surgery. The patient will be given a liquid diet until normal bowel function returns. The recovery time following perineal repair is faster than recovery after abdominal surgery and usually involves a shorter hospital stay (one to three days following perineal surgery, three to seven days following abdominal surgery). The patient will be instructed to avoid activities for several weeks that will cause strain on the surgical site; these include lifting, coughing, long periods of standing, sneezing, straining with bowel movements, and sexual intercourse. High-fiber foods should be gradually added to the diet to avoid constipation and straining that could lead to prolapse recurrence.
Risks associated with rectal prolapse surgery include potential complications associated with anesthesia, infection, bleeding, injury to other pelvic structures, recurrent prolapse, and failure to correct the defect. Following a resection procedure, a leak may occur at the site where two cut ends of colon are reattached, requiring surgical repair.
Most patients undergoing rectal prolapse repair will be able to return to normal activities, including work, within four to six weeks after surgery. The majority of patients will experience a significant improvement in symptoms and have a low chance of prolapse recurrence if heavy lifting and straining is avoided.
The approximate recurrence rates for the most commonly performed surgeries as reported by several studies are as follows:
Abdominal surgeries are associated with a higher rate of complications than perineal repairs; rectopexy, for example, has a morbidity rate of 3–29%, and anterior resection a rate of 15–29%. The complication rate for combined rectopexy and anterior resection is slightly lower at 4–23%. Approximately 25% of patients undergoing anal encirclement will eventually require surgery to treat complications associated with the procedure.
There are currently no medical therapies available to treat rectal prolapse. In cases of mild prolapse where the rectum does not protrude through the anus, a high-fiber diet, stool softeners, enemas, or laxatives may help to avoid constipation, which may make the prolapse worse.
Feldman, Mark, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 7th edition. Philadelphia: Elsevier Science, 2002.
Walsh, Patrick C., et al. Campbell's Urology. 8th edition. Philadelphia: Elsevier Science, 2002.
Felt-Bersma, Richelle J. F., and Miguel A. Cuesta. "Rectal Prolapse, Rectal Intussusception, Rectocele, and Solitary Rectal Ulcer Syndrome." Gastroenterology Clinics 30, no. 1 (March 1, 2001): 199–222.
American Society of Colon and Rectal Surgeons. 85 W. Algonquin Rd., Suite 550, Arlington Heights, IL 60005. (847) 290-9184. http://www.fascrs.org .
Flowers, Lynn K. "Rectal Prolapse." eMedicine, July 30, 2001. [cited April 9, 2003]. http://www.emedicine.com/emerg/topic496.htm .
Poritz, Lisa S. "Rectal Prolapse." eMedicine, February 6, 2003. [cited April 9, 2003]. http://www.emedicine.com/med/topic3533.htm .
Stephanie Dionne Sherk
Rectal prolapse repair is usually performed in a hospital operating room . The surgery may be performed by a general surgeon, a colon and rectal surgeon (who focuses on diseases of the colon, rectum, and anus), or a gastrointestinal surgeon (who focuses on diseases of the gastrointestinal system).
Aside from having Rectocele surgey, at the same time I am having reflex bladder incontinence repair. Could you comment on this surgery too.
Thankyou
Maureen
Proctopexy
suggestions will be appreciated.
I have recently been diagnosed with mucosal prolapse and went through the rectal procedure which did not work. Now they want to do the more invasive procedure in order to correct it for good, hopefully. Dealing with my daughter's issues at birth were much easier than dealing with it happening to me now. I am only thirty-one. I had all three of my children born sunnyside up which put the back of their heads against my tailbone. I have also had a histerectomy which they are saying are very big contributors to what is happening now.
The up side: Now that the Dr knows that I am getting private insurance again, They arnt making me wait one or two months to get an appoint. , and out of the blue are new treatments to try. Now I am scared to go back to them.
P.S. i was 29 when i had the surgery
I know this is over a year after you posted but I had the surgery and I am young and had this surgery in 2006. After spending thousands and having a few surgeries that went bad. I found Dr. Hawkins in Sommerville TN he is awesome and did my surgeries that fixed the problems. He is originally from CA. He is a christian Dr. that doesn't rush you through and he takes his time with you and does all he can to ensure his patients care is the best. I have had one problem since I have moved from TN several hours away and have traveled back to him that's how much I trust him.
Dr. Raymond Hawkins jr. MD
214 Lakeview Road
Somerville, TN 38068-9737
(901) 465-3604
I have a heart complaint and am concerned about having an operation
Please could you reassure me?
I am 78 years old but enjoy life enhancing, due to my prolapse I have now given up for the present I hope, my work at my recent Hospice which cared for my husband before his death.
I am on medication for y heart complaint after having had surgery some years ago.
I am still under the care of Barts Hospital London following the above.
with regards.
Last monday I felt I had another prolapse, went to the doctors and the muscle has collapsed and my bowel has prolapsed. I'm just devestated, I work with aged care but we have a no lifting policy. We shower and dress and feed. Hectic but no lifting at all.
My doctor wants me to try pelvic floor rather than surgery but I want Quality of life its very uncomfortable and may work in 6-8 weeks and maybe not.
Sick of crying, I was working at my health by joining over 50's excercise and water aerobics now this has happened. Is there any advise you could give me.
Many thanks Jenny
I have never discussed this with my primary care doc. I am afraid she will not be familiar with it.
The problem seems to be getting worse.I truly do not want to have surgery or at least not general anesthesia.
Thoughts?
What is the best surgery to repair small and large prolapses?
How long is recovery for small and large prolapses?
Is the perineum a muscle for the anus?
What is the muscle for the anus called?
What is the charge for the violation of the anus?
Anyway last week my intermittent bulging 'rectocele' problem (bulging rectum into vagina, despite rarely suffer with constipation) worsened after tiling my bathroom into the early hours, standing for ages, lifting WorkMate around etc, on top of doing a full time teaching job - leaving me feeling quite weird in the below-the-navel area! It culminated on Saturday evening with me ducked out of a dinner date because I couldn't walk down the road comfortably. I am OK for an hour or so when I get up, but then everything intestinal seems to head south, and I feel I should be holding my stomach up somehow to aleviate the aches... and God forbid I should need to pass a bubble of wind (excruciating!). It can feel somewhat like those Braxton Hicks contractions I used to get prior to going into proper labout... my how you remember things like that, even 35yrs on!! I went to the GP and she confirmed a rectocele by taking a quick peak ("bear down please"), and I am seeing the specialist who did my hysterectomy tomorrow morning. If he offers me pessaries or pelvic floor exercises I shall be disappointed, yet (having read all your stories) I feel really scared at the thought of surgery. Also I guess I want to hear that the rectocele is the problem due to a prolapse, and not due to something else - as recently I feel I am carting a boulder around in pelvis. However I can't really go on dreading coughing/sneezing (ouch, and can precipitate leaking wee), going over bumps when driving the car, and just feeling/looking like I am in early labour when walking around after being up for an hour or so - or when beginning to need to visit the bathroom. Maybe it was a blessing my sex life folded about 3yrs ago, because the thought of it currently is eye watering! Goodnight from across the pond to those who have shared their experiences, and thank you for tips gained from some of them, and all fond and best wishes to those for whom things are still in the melting pot from when things didn't work out. Hazel, UK
my symptoms have always been abdominal discomfort and constipation. throughout the years i have been taking excessive amounts of over the counter laxatives to find relief. I'm now finding out that these laxative pills can damage the nerves in your colon and intestines, numbing your urge to pass stool.
is this what a rectal prolapse is, when you never have the urge to go? i've tried everything, and have never found a good dr who can help me. this is beginning to take an emotional toll on me and i just really need some advice!!
-Denise
Anyone with similar experience?
Kathy
My name is Girish,
weight-46, age-28, height-5'9", working as a DTP operator, (Computer work)
Main topic :
Before 10 to 15 year ago, when I was near 15 to 20 year
I was entered a round plastic (rounding 1' or 3/4') in to my anal and
entering in my back side (anus approx. much more I can) and I do this
activity in many time. I think that this activity very harmful my rectum area,
destroy my rectum motality.
I want to do yoga, running, exercise, but not evacuation properly,
not become pressure and all time feel very heaviness, loss of appetide.
gas, not eating properly, feel weakness, Before 10 year
I take lots of medicine : Like : dulcolex, harad, aloevera, amla, triphala,
isabgol, cremafine, amaltas, papaya, guava, saup, ginger, (kismis, anjeer,
mixed with mil and drink and many more medicine.
I treated in aims continuous two months and do many more test like
enema barium, three blood test, throid test, stool test,
three times altrasound but all reports OK not get any disease.
Sir, I going to slowly slowly in the mouth of death, Please help me.
Thanks!
in CORPUS CHRISTI, TX AREA
PLEASE, PLEASE
after 20 monts of test en biofedback unprofechional en in competant,maby beacouse i'm italian
fter this unbiofeedback the specialist#maby#is riteng me 47 yars since appendicectomy hemorrids,laparoscopy,,adesions his bowel open evry days by digitascion figher en evaquetion is incoplit en is soffer every days we send to surgery,the surgeonis only put me on theatre ward for
ligation of mucosas prolaps en banding emorrhoyd,en this unuman parson as surger is ried me paipars wich tel my =you soffer of severity contipation for mucosas prolaps en rectal inintusussception if u wesch ypu after loock foor surgery foor a starr procedure not in this ospital i'm sorry go back to yor gp colorectal surgeon doctor jankins.Wat u thick abaut this unusual tretmant i have obstruction very serusy iven the lacsativ do not halp my i'm very desparait wat hospital is able foor my problem .CLAUDIO FROAM LONDON #i'm not englesc ther is cure foor me# tanks
the goverment are criminal en wat you can aspact froam criminal only bull schit,fack you england en all quins rich this contry the kill you if you hare halty en in good stile ,immagin if you are seck en you asck foor hap to be cure the esay way is ran off england notting is god in this criminal contry.
is this normal or what .
Ann
Has anyone been advised of what to eat or drink?
I am to young to have this surgery again and in the future have to do it again, very frustrated and embressed
1) What type of doctor should I go to for surgery: A colorectal surgeon that specializes in rectocele, or a urogynecologist who specializes in cycstocele but say they can fix rectoceles as well?
While doing my procedures I was fully awake, hard to twilight me after all the surgeries I have had. I have Crohn's and Celiac Disease. I have been resected once.
When he was finishing up my colon he said I have a prolapsed rectum. He needed my reports from my old GI to compare. Well it's been a week and I can not get off
The couch and running to the bathroom only to have watery stools.
It hurts to go now he did say it was prolapsed and I noticed tonight
It feels like it is hanging out. I hurt, it's painful it itches and burns.
I do have hemmoroids outside and inside but I am very prone to fistula's.
He didn't say anything to me or my husband about what I need to do.
Well it's bad. I love Cleveland and when I email my GI he will reply knowing I am so far away.
Should I email him to let him know it's worse and I have major leakage and having accidents in bed. Then I feel like I need to go and there is nothing there.
I need some relief... Any suggestions???
She is suffering every day with mucus soiling her underwear, fecal incontinance, pain constantly, pain during sex etc. The chirosis was caused by hep.-c virus, and she has been cured of that by taking harvoni. the liver is also getting better. we wre seeing that through blood tests. has anyone else been told that they could not have any of the surgeries due to chirosis?
February 2016. I was warned don't get constipated! So I forced myself to go everyday, and of course I strained
For months afterwards. July 2016, I started having hemorrhoids. I have been examined by 2 different doctors who gave me Proxmine/Steriod cream and assured me it was " just hemorrhoids ". 4 months later, the hemorrhoids look like they are getting larger.
Anyone have any suggestions on how to get rid of these?
I am 10 days post op from a Rectopexy and Sigmoidectomy performed through my abdomen via robotic and laporoscopic surgeries. I spent 6 days in the hospital and was released after having a small bowel movement. Other than incision/abdominal pain and a fiber restricted soft diet, I am healing well. I am on Colase (stool softener) and Alene during the day and am only taking 5 milligrams of Oxy before bed to sleep. I was encouraged to walk the hospital hallways the day after surgery (that was rough) and several times daily during my stay which helps to get things moving. I am continuing to walk around my block and move as much as possible daily but I tire easily at this point. Recovery is expected to be 4-6 weeks and no lifting anything over 10 lbs for 8 weeks. I am an extremely healthy 55 year old with a normal 6-7 day workout routine including cardio and weights so I assume my overall good health has surely been a factor in my recovery. It appears the repairs are working and while the surgery was rough, I feel it is well worth the short-term discomfort for a much better quality of life.
It is a relief to find a place where every story I read feels like my own.