How serious is a rectal prolapse and how can it be treated?

Rectal prolapse, despite being a reasonably common condition, can be a source of discomfort and social unease. Mr Rajeev Peravali, a leading colorectal surgeon from Birmingham, explains the causes of rectal prolapse and how it’s treated to restore your quality of life.

Is rectal prolapse serious?

Rectal prolapse can be very debilitating. It can cause pain, bleeding, bowel incontinence and social isolation. Despite not being a life-limiting condition, it definitely limits the quality of life.

What causes it?

Rectal prolapse is a reasonably common condition and often there is no obvious cause. It happens when the supporting muscles around the rectum become weak allowing it to fall from its normal position. The most common cause for weakening these muscles is childbirth although the prolapse itself may not be evident for years or decades after giving birth.

Many muscles, including those supporting the rectum, get weaker with older age and prolapse is also often seen in older ladies who have not given birth. Chronic constipation, straining and spinal problems are also associated with prolapse.

Can rectal prolapse go away by itself?

Lifestyle modifications may improve symptoms. If the prolapse only appears on straining, it may be possible to alter bowel habits to make the prolapse appear less frequently or not at all. Avoiding straining will avoid prolapse. There are many strategies to do this including:

• avoiding a prolonged period on the toilet
• appropriate toilet positioning
• dietary and fluid modification
• possibly modifying the consistency of the stool with the use of medications

How is rectal prolapse treated?

If conservative measures for small prolapses have not worked or the prolapse is large, the only way to treat rectal prolapse is by surgery. Surgery is complex but can significantly improve quality of life. In general, the surgical options can be divided in to abdominal (those that require a cut in abdomen) or perineal (those that require treating the prolapse from the bottom) procedures.

Abdominal procedure

Rectopexy or resection rectopexy

This may be done by keyhole or laparoscopic means. This is where the prolapsing rectum is “hitched” up and sutured to stop it from prolapsing. This procedure may be combined with a resection of the bowel that is prolapsing (meaning to surgically remove it) and then joining the two ends together.

This procedure always requires a general anaesthetic and is reserved for fit patients.

Perineal (bottom) procedures

There are 2 basic procedures that can be done from the bottom: The Delorme’s Procedure and the Altemeier’s Procedure. The greatest advantage of perineal procedures is that they can be done under spinal anaesthetic.

Delorme’s Procedure

This is where the lining of the prolapse is stripped and the muscle is of the rectum is plicated (folded) with a concertina stitch.

Altemeier’s Procedure

This is where the prolapse is cut away from the bottom and the two ends are stitched back together.

To receive Mr Peravali’s first-class patient care, visit his profile and arrange your online or face-to-face consultation.