How is rectal prolapse treated?
In some cases of very minor, early prolapse, treatment can begin at home with the use of stool softeners and by pushing the fallen tissue back up into the anus by hand. However, surgery is usually necessary to repair the prolapse.
There are several surgical approaches. The surgeon’s choice depends on patient’s age, other existing health problems, the extent of the prolapse, results of the exam and other tests and the surgeon’s preference and experience with certain techniques.
Abdominal and rectal (also called perineal) surgery are the two most common approaches to rectal prolapse repair.
Abdominal repair approaches
Abdominal procedure refers to making an incision in the abdominal muscles to view and operate in the abdominal cavity. It is usually performed under general anesthesia and is the approach most often used in healthy adults.
The two most common types of abdominal repair are rectopexy (fixation [reattachment] of the rectum) and resection (removal of a segment of intestine) followed by rectopexy. Resection is preferred for patients who have severe constipation. Rectopexy can also be performed laparoscopically through small keyhole incisions, or robotically, making recovery much easier for patients.
Rectal (perineal) repair approaches
Rectal procedures are often used in older patients and in patients who have more medical problems. Spinal anesthesia or an epidural (anesthesia that blocks pain in a certain part of the body) may be used instead of general anesthesia in these patients. The two most common rectal approaches are the Altemeier and Delorme procedures:
- Altemeier procedure: In this procedure -- also called a perineal proctosigmoidectomy -- the portion of the rectum extending out of the anus is cut off (amputated) and the two ends are sewn back together. The remaining structures that help support the rectum are stitched back together in an attempt to provide better support.
- Delorme procedure: In this procedure, only the inner lining of the fallen rectum is removed. The outer layer is then folded and stitched and the cut edges of the inner lining are stitched together so that rectum is now inside the anal canal.
What are the risks/complications that may occur after rectal prolapse surgery?
As with any surgery, anesthesia complications, bleeding and infection are always risks. Other risks and complications from surgeries to repair rectal prolapse include:
- Lack of healing where the two ends of bowel reconnect. This can happen in a surgery in which a segment of the bowel is removed and the two ends of the remaining bowel are reconnected.
- Intra-abdominal or rectal bleeding
- Urinary retention (inability to pass urine)
- Medical complications of surgery: heart attack, pneumonia, deep venous thrombosis (blood clots)
- Return of the rectal prolapse
- Worsening or development fecal incontinence
- Worsening or development of constipation
After surgery, constipation and straining should be avoided. Fiber, fluids, stool softeners and mild laxatives can be used.