What is Rectal Prolapse
Rectal prolapse is a distressing condition whereby part of the rectum slides downwards and protrudes through the anal opening. It is most common in female patients and tends to occur most in elderly ladies who have experienced childbirth; although up to a third of women with rectal prolapse will not have had children and the condition can also affect men. Children may also be affected in certain circumstances.
External rectal prolapse is often associated with constipation and chronic straining to have bowel movements. Patients with rectal prolapse often report a mass protruding through the anus. Initially, the prolapse usually protrudes from the anus only after defecation and spontaneously returns to the anatomical [normal] position. However, as the condition progresses, the prolapse tends to occur more frequently. Eventually, the rectum prolapses with daily activities such as walking and may prolapse all the time. Other than the rectum protruding, patients can experience problems of incontinence, bleeding, mucous discharge and soreness.
The surgeon will listen to the history and then examine the patient. It is important to document the prolapse and, often, the patient is asked to sit on a commode and strain to produce the prolapse for inspection. Prolapse is sometimes associated with anal incontinence and if there are other pelvic floor symptoms, such as urinary incontinence, then an MRI defaecography scan may also be helpful. Sometimes we will wish to screen the colon, by colonoscopy or CT, for underlying conditions prior to surgery.
Surgery is the mainstay of treatment for rectal prolapse. Until recently, there were two main approaches to surgery: operation via the abdomen, or operation directly onto the prolapse from below. Unfortunately, the abdominal procedure required a large abdominal incision and this limited the uptake of the procedure. More recently, with the emergence of keyhole (laparoscopic) surgery we have been able to offer the benefits of an abdominal procedure without imposing a large incision on the abdomen.
Laparoscopic rectopexy is a minimally invasive operation that is suitable for almost all patients with rectal prolapse. The procedure can either be performed as a conventional rectopexy, or as a ventral rectopexy; your surgeon will advise you which is most appropriate. Under general anaesthetic and using keyhole techniques, the surgeon mobilises the full rectum, or just the front aspect of the rectum (in ventral rectopexy) and implants a piece of surgical mesh; the mesh is attached from the rectum to the sacrum bone and this holds the rectum in the anatomical position. The patient is usually out of hospital within 48 hours and is discharged home on laxatives for the first few weeks postoperatively.