Prolapse

Rectal prolapse (procedentia) is when the rectum protrudes through the anus. This may be partial (mucosa) or complete (full thickness). Rectal prolapse often occurs in isolation, but may be accompanied by bladder and uterine prolapse.

Rectal prolapse occurs when the complex suspensory ligaments and normal attachments of the rectum fail. The common causes of rectal prolapse are listed below

  • Advancing age
  • Chronic constipation
  • Chronic diarrhoea
  • Rectal mass
  • Increased abdominal pressure

In some situations rectal prolapsed may go unnoticed, but most patients will experience one or more of the following symptoms:

  • A sensation of something ‘coming down’ or protruding from the anus
  • Faecal incontinence
  • Discharge or bleeding
  • Anal pain

Almost all cases of symptomatic rectal prolapse require surgical care. It is important for your surgeon to first exclude a rectal mass or cancer causing the prolapse. The aim of surgery to to return the rectum to it’s anatomical position and relieve the symptoms.

There are various operations available to treat rectal prolapse, and includes

  • Laparoscopic ventral rectopexy
  • Delormes procedure
  • Altemeier procedure

Laparoscopic ventral rectopexy

This is currently the best operation for rectal prolapse in terms of recurrence and cure rate. It is an operation done via the abdomen in which the rectum is pulled back up, and held in place by a piece of mesh placed behind the rectum. The mesh causes scar tissue that holds the rectum in its new ‘elevated’ position and replicates the previous support that the rectum had prior to the prolapse.

It can be performed as a laparoscopic (key-hole) operation and in the majority of cases does not require any of the bowel to be removed.

Delormes Procedure

This is a relatively painless operation, that is completed via the perineum (anus). The excess prolapsing bowel is carefully removed from the attenuated muscular coat of the bowel wall, and sewn back together. It can improve continence and allows a very quick and safe surgical procedure, with very little surgical stress on the body. It is ideal for patients in whom an abdominal approach is not suitable.

Altemeier Procedure

Similarly to the Delorme’s procedure, the Altemeier Procedure is performed via the perineum, and as such, has all the benefits of the Delorme’s operation. It is a different technique, in that the excess rectum is removed as a bowel resection and rejoined onto the anus. This technique allows bowel to be removed if it is not healthy, or there is a large amount of redundant rectum, that may contribute to recurrence.

Dr Kariappa would be happy to go through the indications, benefits and recurrence rates for each operation.

Rectal prolapse can be an embarrasing and symptomatic problem that need not be. Surgery can cure this problem with very low morbidity, and very little time in hospital.