Rectal prolapse repair

Definition
This procedure is surgery to repair a rectal prolapse, the protrusion of the rectum (the last part of the colon) through the anus.

Description

Rectal prolapse may be partial, involving only the mucosa, or complete, involving the entire wall of the rectum. It can occur in children but is much more common in older individuals.

Rectal prolapse in infants often gets better on its own and does not require surgery. Children with myelomeningocele and bladder exstrophy as well as children with Cystic fibrosis are particularly at risk. Rarely it can be caused by acute diarrhea or straining to pass stool while constipated.

Rectal prolapse is most common in older individuals with a long history of Constipation or weakness of the pelvic floor muscles. It is more common in women, especially those who have had a hysterectomy.

SYMPTOMS:

The symptoms of rectal prolapse include anorectal pain, bleeding, mucous discharge from the anus, and incontinence. Patients may also notice protrusion of rectal tissue while having bowel movements and may need to push it back in manually.

This condition can be confused with hemorrhoids but is actually quite different.

SURGERY:

Surgery is required to correct rectal prolapse in adults and in some children. Most surgical procedures for rectal prolapse are done under general anesthesia. For older or sicker patients, there are some options using epidural or spinal anesthesia.

There are three basic surgical approaches to repair rectal prolapse. Your surgeon will decide which one is best suited to you.

For medically fit adults, an abdominal procedure has the best chance of success. With the patient under general anesthesia, an abdominal incision is made and a portion of the colon is removed. The rectum may be sutured to the surrounding tissue. Sometimes a soft piece of mesh is wrapped around the rectum to help it stay in place. This procedure can also be done with laparoscopic surgery (also known as “keyhole” or “telescopic” surgery).

For older adults or those with other medical problems, an approach from below (perineal approach) might be less risky, although with the perineal procedure, the condition will be more likely to recur. With the patient under general, epidural, or spinal anesthesia, the prolapsing rectum or colon can be treated from the pelvic floor (perineum) either by removing a portion of the colon or suturing the rectum to the surrounding tissues, or both.

Very frail or sick patients may be considered for a small procedure to reinforce the sphincter muscles by encircling them with a band of soft mesh or a silicone tube. This approach provides only temporary improvement and is rarely used.

Indications
For children, rectal prolapse does not always require surgical correction. Infant prolapse often disappears without intervention.

Surgery to repair rectal prolapse is advised for most adults, and for children with continued rectal prolapse that does not improve over time.

Risks
Risks for any anesthesia include the following:

     
  • Reactions to medications  
  • Breathing problems, Pneumonia  
  • Heart problems

Risks for any surgery include the following:

     
  • Bleeding  
  • Infection

Additional risks include the following:

     
  • Constipation is very common, although most patients have Constipation before the surgery.  
  • Incontinence occurs in 10-20% of patients following surgery. This is often an improvement over incontinence that is present before the surgery. However, in a small number of patients, incontinence can get worse.  
  • Recurrence of prolapse occurs in 5-10% of abdominal repairs and about 15-25% of perineal repairs.

Expectations after surgery
The surgery is usually effective in repairing the prolapse. The long-term prognosis is good. Constipation and incontinence can be a problem for some patients.

Convalescence
Hospital time depends on the procedure used. Average stay for open abdominal procedures is 5-8 days and is shorter for laparoscopic surgery. Average stay for perineal surgery (approach from below) is 2-3 days. Expect complete recovery in 4-6 weeks.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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