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Rectal prolapse repair

Definition

Rectal prolapse repair is surgery to fix a rectal prolapse, in which the rectum (the last part of the colon) protrudes through the anus.

Description

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

Rectal prolapse in infants often gets better on its own and does not require surgery. Children with the following conditions are at greatest risk:

• Bladder exstrophy
• Cystic fibrosis
• Myelomeningocele

Rarely the condition can be caused by acute diarrhea or straining to pass stool while constipated.

Rectal prolapse is most common in older adults 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:

• Pain in the anus and rectum (anorectal pain)
• Bleeding
• Mucus discharge from the anus
• Incontinence
• Rectal tissue sticking out while having bowel movements (it may need to be pushed back in manually)

This condition can be confused with hemorrhoids but is 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, epidural or spinal anesthesia may be used.

There are three basic types of surgery to repair rectal prolapse. Your surgeon will decide which one is best for you.

For healthy adults, an abdominal procedure has the best chance of success. While you are under general anesthesia, the doctor makes a surgical cut in the abdomen and removes a portion of the colon. The rectum may be attached (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. However, with the perineal procedure, the condition will be more likely to come back (recur).

While you are under general, epidural, or spinal anesthesia, the prolapsing rectum or colon can be treated from the pelvic floor (perineum). The doctor will either remove a portion of the colon or suture the rectum to the surrounding tissues, or both.

Very frail or sick patients may need a small procedure to reinforce the sphincter muscles. This technique encircles the muscles 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 surgery. However, children whose rectal prolapse does not improve over time may need surgery. Infant prolapse often disappears without treatment.

Surgery to repair rectal prolapse is advised for most adults.

Risks

Risks for any anesthesia include the following:

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

Risks for any surgery include the following:

• Bleeding
• Infection

Other risks include:

• Constipation is very common, although most patients have constipation before the surgery.
• Incontinence after 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.
• Return of prolapse during abdominal repairs and 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.

References

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and Rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Townsend: Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 50.