Rectal prolapse surgery is performed in people troubled by chronic symptoms, including difficulty pushing the rectum back in place, leakage of stool or inability to control bowel movements (fecal incontinence), or obstructed bowel movements. The problem is most common in elderly women.
For occasional rectal prolapse, self-care measures may help
For some people, minor rectal prolapse occurs occasionally when they strain to have a bowel movement. In these people, rectal prolapse may go away on its own. Rectal prolapse may be prevented by eating a high-fiber diet, drinking plenty of liquids, and taking laxatives, stool softeners and stool-bulking agents.
Rectal prolapse surgery carries a risk of serious complications. Each technique for repairing rectal prolapse has its own risks. But in general, rectal prolapse surgery risks include:
- Bowel obstruction
- Damage to nearby structures, such as nerves and organs
- Fistula — an abnormal connection between two body parts
- Recurrence of rectal prolapse
- Worsened constipation
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 special antibacterial 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 to several days in the hospital after rectal prolapse surgery. Plan ahead so that you'll be as comfortable as possible during your stay. Consider bringing:
- Personal care items, such as your toothbrush or your shaving supplies
- Comfortable clothes, such as a robe and slippers
- Entertainment, such as books and games
During rectal prolapse surgery
Rectal prolapse surgery can be done through the abdomen — either with a large incision (open surgery) or laparoscopic methods — or through the region around the anus (perineum).
Which approach your surgeon uses depends on a number of factors, such as the suspected cause of rectal prolapse, your other health problems, and your surgeon's experience and preferences. There is no clear-cut advantage to any approach. Discuss your options with your surgeon.
Types of rectal prolapse surgery comprise:
Rectal prolapse repair through the abdomen
In a procedure sometimes called rectopexy, the surgeon pulls the rectum back inside the body and, to keep it in place, attaches the rectum to the tissue around the sacrum — the bony structure above your tailbone and below your spine. The surgeon may secure the rectum with sutures or with a mesh sling that supports the rectum. In some cases, the surgeon may also remove a portion of the colon in a procedure called resection rectopexy.
Rectal prolapse surgery may also be performed using several smaller incisions in the abdomen. This procedure is sometimes called laparoscopic rectal prolapse surgery. The surgeon inserts special surgical tools and a tiny camera through the abdominal incisions to repair the rectal prolapse.
The abdominal approach to rectal prolapse surgery requires general anesthesia to put you in a sleep-like state during the procedure.
Rectal prolapse repair through the perineum
Rectal prolapse surgery through the area around the anus (perineum) is sometimes called perineal rectosigmoidectomy. During this procedure, the surgeon removes a portion of the rectum and sigmoid and attaches the remaining rectum to the large intestine (colon). This procedure is also called the Altemeier surgery.
Another method for repairing a rectal prolapse through the perineum is called the Delorme procedure. This surgery is typically only done for short prolapses. The lining of the rectum is removed and the muscular layer folded to shorten the rectum.
Some people who have rectal prolapse also have other health issues such as vaginal prolapse or pelvic organ prolapse. If this is the case, surgery to repair a rectal prolapse can be combined with surgery to treat problems such as a cystocele, uterine prolapse or rectocele.
Perineal rectosigmoidectomy can be performed using regional anesthesia, during which you remain awake. It is most often used with frailer older people who may not tolerate the abdominal operation.
After rectal prolapse surgery
You'll spend a brief time in the hospital recovering and regaining your bowel function. You may begin by drinking clear liquids and eventually transition to solid foods. How much time you spend in the hospital will depend on what procedure was used for your rectal prolapse surgery. For most perineal procedures, it could be just an overnight stay.
Your doctor will likely recommend drinking lots of fluids, use of stool softeners and a diet rich in fiber in the weeks following surgery, to avoid constipation and excessive straining that may lead to recurrence of the rectal prolapse. Most people will be able to return to normal activities within four to six weeks after surgery.
Some people may need help from a physical therapist in relearning how to properly use the pelvic floor muscles.
In studies of the different ways of performing rectal prolapse surgery, no procedure has proved to be optimal for all people. Each has advantages and disadvantages, but all have similar results in terms of safety, effectiveness and recurrence rates.
For most people, rectal prolapse surgery relieves the symptoms of rectal prolapse and improves fecal incontinence. It may take a year to assess how surgery has affected bowel function.
Most published studies of results of rectal prolapse surgery report improvement in constipation for most people. But they also indicate that constipation can get worse and become a problem when it wasn't one before. If you have constipation issues, it's important to address them before having surgery.
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. Talk with your doctor about your risk of recurrence and what you can do to reduce your risk.