Colorectal surgery

Rectal prolapse

What is rectal prolapse?

Protrusion of the rectum (the last part of the intestine which stores and evacuates stools) through the anus to the outside is called Rectal prolapse.

What is the Rectum?

Rectum is the terminal part of the large intestine. It has very important function of storage and evacuation (defecation) of stools. It is situated deep inside the bony pelvis.

What causes Rectal prolapse?

The rectum is surrounded by fatty and connective tissue and is anchored to the pelvis and the surrounding structures by the connective tissue. When the rectum losses its support, it tends to slide down due to the movements of the bowels

What are the symptoms?

  • Mass of tissue coming out through the anus while passing stools / straining, which reduces spontaneously or by pushing it up. This is small to start with and gradually increases in size. Most often the prolapse reduces itself or can be easily pushed inside, this happens every time the
  • Bleeding while passing stools,
  • Discomfort while passing stools,
  • Constipation- many patients have associated constipation,
  • Severe pain and irreducibility when the prolapse fails to go inside, this can lead to swelling and gangrene of the prolapse (Strangulation)

What are the complications of rectal prolapse?

  • Bleeding
  • ulceration
  • gets worse with time
  • Acute prolapse, incarceration and strangulation– this is a dread complication, where the rectum suddenly comes out while straining and does not go back. The prolapsed rectum gets swollen, becomes red and can lose its blood supply and become gangrenous. This is a serious and emergency condition which needs immediate management in the form of reduction under anaesthesia or emergency surgery.

Whom to consult?

A qualified surgical gastroenterologist is the right person who can deal with the condition.

What is the treatment?

Rectal prolapse has to be treated, an untreated prolapse leads to complications.

“Surgery is the best and the only available treatment”

Surgery is performed either trans abdominal or through the perineum (from below). Laparoscopic Rectopexy is the procedure of choice.

What are the tests to be done?

A thorough clinical examination by the surgeon is the simplest bed side test. The surgeon can confirm the prolapse and assess the anal tone.

A colonoscopy and a Barium enema (X ray taken after instilling a contrast agent into the anal canal) are done in selected cases.

What is Laparoscopic Rectopexy?

Rectopexy is a procedure for surgical correction of the rectal prolapse. The prolapsing rectum is mobilized and fixed with sutures or a mesh to the bony pelvis behind the rectum. This prevents the rectum from sliding down and prolapsing out of the anus.

What is the post operative recovery after surgery?

Patient is evaluated on outpatient basis. The procedure is generally performed under General Anaesthesia.

Recovery after surgery is quick and most of the patients are discharged in a day or two after surgery.

What are the advantages of Laparoscopic surgery over open surgery?

Laparoscopic surgery offers several distinct advantages to the patient:

  • Pain after surgery is much less or minimal,
  • Wounds are small, they heal fast
  • The risk of wound infection is less
  • Scars are small and imperceptible, cosmetically better looking
  • Reduced intra-abdominal adhesions
  • Reduced chances of incisional hernias
  • Early recover after surgery
  • Early resumption of physical activities after surgery
  • Short hospital stays