Rectal Prolapse Surgery
Overview
Rectal prolapse happens when the rectum slips out through the anus. This condition may require surgery to fix the problem and return the rectum to its normal position.
Surgeons can use different procedures based on each person’s medical needs. The main goal of rectal prolapse surgery is to reduce symptoms and prevent future episodes. Doctors choose the safest and most effective method for the patient.
Reasons for Performing the Procedure
Rectal prolapse surgery addresses problems caused by the rectum slipping out of place. It often aims to relieve pain and discomfort, correct fecal incontinence, manage obstructed or difficult bowel movements, and help with chronic constipation.
Main Goals
- Prevent fecal leakage.
- Restore control over bowel movements.
- Alleviate pelvic floor issues and constipation.
Possible Complications and Risks
Rectal prolapse surgery may lead to certain problems. Common complications include:
- Bleeding or rectal bleeding
- Infection at the surgical site
- Bowel blockage
- Injury to nearby nerves or organs
- Unintended connection between body parts (fistula)
- Sexual issues
- New or worse constipation
- Recurrence of the prolapse
The recurrence rate and overall morbidity depend on the type of procedure.
Getting Ready for Surgery
Doctors usually recommend using an antiseptic soap to shower before surgery to help lower the risk of infection. Patients should also ask if they need to stop taking any medicines before the procedure; sometimes, a doctor will advise stopping certain medications.
Doctors may order tests like colonoscopy, defecography, or a barium enema to check the condition and help with planning. Bringing items from home is helpful, such as a toothbrush, hairbrush, or comfortable clothing. A list of items to consider:
- Personal care products
- A robe and slippers
- Books or games for entertainment
Ask the medical team if stool softeners are necessary before or after surgery.
What you can expect
Before surgery day
Most patients meet with their surgeon to go over the best treatment plan for their condition. The doctor decides which type of operation is best based on the size of the prolapse, patient age, other health concerns, and their own experience.
The main options are operations through the belly (abdominal approach) or around the anus (perineal approach). The anesthesia team gives patients either general anesthesia (the patient is fully asleep) or a numbing shot in the lower back (spinal block).
The doctor will explain which one they plan to use for the surgery. Before going to the hospital, patients might be asked not to eat or drink for several hours. They may also need to arrange for help at home after surgery.
What Happens in the Operating Room
Surgeons use several techniques to repair rectal prolapse and choose the most suitable one:
Abdominal (Belly) Surgery: The surgeon makes a cut in the lower stomach to move the rectum back to its natural position. The rectum is then attached to the bony part of the pelvis using stitches or mesh. If the patient has frequent constipation, the surgeon may remove part of the colon.
Minimally Invasive Approaches: In laparoscopic surgery, the surgeon makes small cuts on the belly and uses special tools plus a camera to perform the operation. Sometimes, a robot helps guide the surgeon’s movements. These methods often mean less pain and faster healing for some patients.
Perineal (Around the Anus) Surgery: For those who are not good candidates for belly surgery, the surgeon might use the perineal approach. In procedures like the Altemeier technique, the surgeon gently pulls the rectum out through the anus, removes the damaged section, and stitches the healthy ends back together. The Delorme technique removes just the inner lining of the rectum and shortens the muscle layer.
If the patient has other pelvic problems, such as vaginal or pelvic organ prolapse, the surgeon may fix those at the same time.
Commonly used surgical treatments
| Type of Approach | Technique Name | Typical Candidates |
|---|---|---|
| Abdominal | Rectopexy, Laparoscopic, Robotic | Most adults, depending on health |
| Perineal | Altemeier, Delorme | Older adults or those with other illnesses |
Recovery and Care After Surgery
After surgery, most patients stay in the hospital for a short time. The length of stay depends on the type of operation:
- Open abdominal surgery usually requires a stay of 5 to 8 days.
- Laparoscopic or perineal approaches may allow discharge after just 2 to 3 days.
Recovery begins with clear liquids, followed by the gradual addition of soft foods as the body adjusts. To support healing and reduce strain during bowel movements, doctors commonly suggest:
- Drinking plenty of fluids
- Taking stool softeners
- Eating high-fiber foods
These habits help prevent constipation and make recovery smoother. Most people return to their usual routine within 4 to 6 weeks. In some cases, doctors may recommend working with a physical therapist. Therapy helps patients strengthen and properly use pelvic muscles, which can lower the risk of prolapse returning.
Surgical Outcomes and Recovery
Most individuals experience relief from rectal prolapse symptoms after surgery. Many see improvements in both fecal incontinence and constipation. However, some people may notice constipation either getting worse or starting for the first time after the operation. For those who had constipation before, discuss ways to manage it with a healthcare provider.
Recurrence Rates
| Surgery Type | Chance of Prolapse Returning |
|---|---|
| Perineal Procedure | Up to 5% |
| Abdominal Procedure | About 2% |
