Understanding Rectal Prolapse Surgery

A rectopexy is often performed when there is a protrusion of the rectum through the anus known as a prolapse. In other words, the rectum, which is located at the end of your large intestine, ceases to be supported in its normal position in the body. It either falls or slides down through the anus. The procedure is also known as the rectal prolapse surgery.

Although a prolapsed rectum isn’t life-threatening, it can certainly be life-altering as it causes a host of distressing symptoms. Over time, the condition can worsen. Rectal prolapse is considered uncommon, with approximately 2.5 reported cases in 100,000 people, according to the American Society of Colon and Rectal Surgeons (ASCRS).

Rectal prolapse typically occurs six times more often in women 50 years or older than in men of the same age. However, men and children can have rectal prolapse as well.

The main reason your doctor will perform a rectopexy is to correct and repair the rectal prolapse so that it can function in a normal fashion. There are three primary types of rectal prolapse where surgery may be considered. These include the following instances:

• The rectum has fallen from its normal position, but it remains inside the anus.
• A portion of the rectum protrudes through the opening of the anus.
• The complete rectum has fallen outside the anus.

The treatment for rectal prolapse depends on the severity of the condition and symptoms. When surgery is required, there are three types of approaches to consider.

The first, an abdominal rectopexy, aims to repair the prolapsed organ by entering the belly with one open incision. The second approach, a laparoscopic procedure, requires smaller incisions—the surgeon uses a camera and specially-designed surgical instruments to correct the rectal prolapse.

The third type, a perineal approach, treats rectal prolapse by entering the region around the anus. All three procedures involve freeing the rectum from the tissues around it and repositioning it into its proper place using stitches. In some cases, mesh may be used to support the rectum and secure it in place.

At the present time, there isn’t a consensus over which approach is best, as stated in an article from the Journal of Minimal Access Surgery. An abdominal operation, in general, is most often done as a laparoscopic procedure. This is thought to lead to better outcomes and a reduced risk of recurrence.

The perineal approach may be used in cases where a person isn’t able to undergo an abdominal procedure.

However, to decide which surgery is right for you, your doctor will need to consider factors like your age, other health conditions, and the best way to alleviate the symptoms. Symptoms which may warrant consideration for a rectopexy include:

• Constipation
• Leaking of stool or fecal incontinence
• Rectal bleeding
• Drainage of mucus
• Pain in the rectum or anus
• Weakness in the muscles that support the rectum
• Other changes in bowel habits

A rectopexy isn’t a risk-free procedure—it can lead to serious complications. The risks may differ depending on the type of procedure that is used and an individual’s medical history. Patients with a score that’s considered high on the body mass index (BMI) are more apt to experience complications, and their doctor may decide that one surgery is a safer approach than another.

However, it’s important to note that most people make a successful recovery following the surgery. A general list of risks associated with this operation include:

• An infection
• Changes in bowel habits such as increased constipation or diarrhea
• Recurrence of the rectal prolapse
• Pain
• Bleeding
• A bowel obstruction
• Incontinence of the bowel
• Damage to organs, tissues, or nerves in the vicinity of the operation
• Development of a fistula

The day before the operation, you may be asked to use a medication, like an enema or laxative, to flush out the bowel and any remaining fecal matter in preparation for the surgery. This process is known as mechanical bowel preparation. Your physician might also ask you to shower using a soap that disinfects your skin to reduce the growth of microorganisms that could lead to infection.

You may also be asked to stop your intake of food, drink, and certain medications the night prior to the surgery. In some cases, you might be able to take critical medications, but with a small amount of liquid. Additionally, you may receive intravenous (IV) antibiotics right before the procedure to further reduce your risk of infection.

You’ll need to stay in the hospital for at least a day so after the procedure so that your healthcare team can monitor your progress, watch for signs of infection, provide pain medication, and assess your bowel function.

You might be asked to eat a special diet, which might consist of things like increasing your fluid intake and eating softened or fiber-rich foods to prevent constipation. When you leave the hospital and head home, you’ll be given a post-operative appointment to check your recovery.

Most often, the surgery works to alleviate the symptoms of rectal prolapse. Rectal prolapse recurs in approximately 2 to 5% of those who’ve had the surgery. Additionally, for some people, there may be a change in bowel habits.

For example, some patients may experience a new onset of constipation following the surgery. You’ll want to talk to your doctor if any new symptoms arise so that you can discuss new ways to ease any discomfort.

Once you leave the hospital, you’ll be provided instructions to gradually increase your activity level. You might be asked to walk in a low-impact way to use your muscles and increase circulation. If you have weak muscle tone in the pelvic floor muscle, which holds your rectum in place, your doctor may want you to see a physical therapist. As with any procedure, if you have questions or concerns, be sure to talk with your doctor so you can get back to your daily life.