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Rectal prolapse repair

Definition

Rectal prolapse repair is surgery to fix a rectal prolapse. This is a condition in which the last part of the colon (called the rectum) sticks out 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.

For most adults, surgery is used to repair the rectum because there is no other effective treatment.

Children with rectal prolapse do not always need surgery, unless their prolapse does not improve over time. In infants, prolapse often disappears without treatment.

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 so it will not slide and fall out through the anus. Sometimes, a soft piece of mesh is wrapped around the rectum to help it stay in place. These procedures 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 through the anus (perineal approach) might be less risky. It might also cause less pain and lead to a shorter recovery. But with the perineal approach, the condition is more likely to come back (recur).

One of the surgical repairs through the anus involves removing the prolapsed rectum and colon and then suturing the rectum to the surrounding tissues.  This procedure can be done under general, epidural, or spinal anesthesia.

Very frail or sick patients may need a smaller procedure that reinforces the sphincter muscles. This technique encircles the muscles with a band of soft mesh or a silicone tube. This approach provides only short-term improvement and is rarely used.

Risks

Risks of anesthesia include the following:

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

Risks of this surgery include the following:

  • Bleeding
  • Infection -- If a piece of rectum or colon is removed, the bowel needs to be reconnected. In rare cases, this connection can leak, causing infection. More procedures may be needed to treat the infection.
  • Constipation is very common, although most patients have constipation before the surgery.
  • Incontinence that is present before the surgery often improves. In a small number of patients, incontinence can get worse.
  • Return of prolapse after abdominal or perineal surgery

Before the Procedure

During the 2 weeks before your surgery:

  • You may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen, naprosyn, and warfarin.
  • Ask your doctor which medicines you should still take on the day of your surgery.
  • If you smoke, try to stop. Ask your doctor for help.
  • Let your doctor know if you have been sick before your surgery. This includes a cold, flu, herpes flare-up, urinary problems, or any other illness.
  • Eat high-fiber foods and drink 6 to 8 glasses of water every day.

The day before your surgery:

  • Eat a light breakfast and lunch.
  • You may be told to drink only clear liquids such as broth, clear juice, and water after noon.
  • Follow instructions about not eating or drinking after midnight.
  • You may be told to use enemas or laxatives to clear out your intestines. If so, follow those instructions exactly.

On the day of your surgery:

  • Take any medicines that your doctor told you to take with a small sip of water.
  • Be sure to arrive at the hospital on time.

After the Procedure

How long you stay in the hospital depends on the procedure. The average stay for open abdominal procedures is 5 to 8 days. You will go home sooner if you had laparoscopic surgery. The average stay for perineal surgery is 2 to 3 days. 

You should make a complete recovery in 4 to 6 weeks.

Outlook (Prognosis)

The surgery usually works well at repairing the prolapse. Constipation and incontinence can be problems for some patients.

References

Fry RD, Mahmoud NN, Maron DJ, Bleier JIS. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 52.

Melton G, Kwaan MR. Rectal prolapse. Surg Clin N Am. 2013;93:187-198.


Review Date: 5/8/2014
Reviewed By: Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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