Rectal Prolapse Surgery (Rectopexy)

Rectal prolapse is a condition that affects the quality of life. It happens when the rectum bulges out through the anus. To treat it, surgery like rectopexy is often used.

Rectopexy is a surgery that fixes rectal prolapse. It moves the rectum back into place and holds it there. This helps fix problems like pain, incontinence, and constipation.

For those dealing with rectal prolapse, rectopexy brings hope. It improves bowel function and overall health. This surgery helps patients feel better and more confident in their daily lives.

What is Rectal Prolapse?

Rectal prolapse happens when the rectum bulges out through the anus. This is due to weak tissues that normally hold it in place. It can make life very uncomfortable and affect your quality of life a lot.

It can happen to anyone, but mostly to older women. It often starts slowly as the body ages. Sometimes, it’s linked to other health issues or surgeries that weakened the pelvic floor.

Symptoms of Rectal Prolapse

The main sign is when the rectum bulges out during bowel movements or when you move. Other common rectal prolapse symptoms include:

• A feeling of fullness or pressure in the rectum
• Mucus discharge from the protruding tissue
• Fecal incontinence or difficulty controlling bowel movements
• Pain or discomfort during bowel movements
• Bleeding from the rectum

These symptoms can vary from mild to severe. They may come and go. Many people also have chronic constipation, which makes things worse.

Causes of Rectal Prolapse

Several things can lead to rectal prolapse. Some common causes of rectal prolapse include:

• Weakening of the pelvic floor muscles due to aging, pregnancy, or childbirth
• Chronic constipation or straining during bowel movements
• Prior pelvic surgeries, such as hysterectomy
• Nerve damage from conditions like diabetes or spinal cord injuries
• Connective tissue disorders, such as Ehlers-Danlos syndrome

Often, a mix of these factors leads to rectal prolapse. Finding and treating the root causes is key to managing and preventing it.

Diagnosing Rectal Prolapse

Getting a correct diagnosis for rectal prolapse is key to finding the right treatment. Doctors use a detailed physical check-up and special imaging tests. These help figure out how bad the prolapse is and how far it has gone.

Physical Examination

During a physical check-up, the doctor looks at the anus and rectum for signs of prolapse. The patient might be asked to strain like they’re having a bowel movement. This makes the prolapse easier to see.

The doctor also checks the anal sphincter tone. They look for other issues, like hemorrhoids or fissures, too.

Imaging Tests

Imaging tests are also important for diagnosing rectal prolapse. Two main tests are used:

The findings from these tests and the physical check-up help the doctor know exactly what’s going on. They can then suggest the best treatment, which might be non-surgical or surgery like rectopexy.

Non-Surgical Treatment Options for Rectal Prolapse

For mild cases of rectal prolapse, non-surgical treatment options are often suggested first. These methods aim to ease symptoms and enhance life quality. Simple changes like eating more fiber, drinking plenty of water, and avoiding hard bowel movements can help manage rectal prolapse.

Pelvic floor exercises, or Kegel exercises, can also be beneficial. They strengthen the muscles around the rectum, potentially stopping the prolapse from getting worse. A physical therapist can teach you how to do these exercises correctly and tailor a plan just for you.

In some cases, a pessary is used to support the rectum and prevent prolapse. Pessaries are custom-made and come in different shapes and sizes. They need regular cleaning to work well.

It’s key to remember that non-surgical treatments can help manage symptoms but might not work for severe cases. If these methods don’t help enough or if the prolapse is very severe, surgery might be needed. A healthcare provider will decide the best course of action based on your specific situation.

Rectal Prolapse Surgery (Rectopexy)

If non-surgical treatments don’t work, surgery might be needed. Rectopexy is a surgery that tries to fix the rectum and stop it from slipping out. The type of surgery depends on how bad the prolapse is, the patient’s age and health, and any other health issues.

Indications for Rectopexy

Rectopexy is usually suggested for those with:

• Full-thickness rectal prolapse that doesn’t get better with non-surgical treatments
• Rectal prolapse that keeps coming back after surgery
• Big problems like not being able to control bowel movements, constipation, or pain
• Quality of life is really bad because of the prolapse

Types of Rectopexy Procedures

There are different ways to do rectopexy, each with its own benefits and when to use them:

The type of rectopexy depends on the surgeon’s skill and what the patient needs. Sometimes, a mix of methods is used for the best results. Your doctor will talk about the best choice for you, based on your age, health, and how severe the prolapse is.

Laparoscopic Rectopexy: A Minimally Invasive Approach

Laparoscopic rectopexy is a minimally invasive surgical technique. It’s better than traditional open surgery for treating rectal prolapse. This method uses small incisions in the abdomen. Through these, instruments and a camera are inserted.

The surgeon then does the rectopexy procedure. This involves attaching the rectum to the sacrum with sutures or mesh.

Compared to open surgery, laparoscopic rectopexy has many benefits:

During the surgery, the surgeon might also fix other pelvic floor issues. This includes rectocele or enterocele. Using mesh can help strengthen the repair and lower the chance of it happening again.

Even though laparoscopic rectopexy is safe and works well, it’s key to talk to your surgeon. They can tell you if this minimally invasive approach is right for you. Many people choose it because it’s less invasive.

Perineal Approach to Rectal Prolapse Surgery

The perineal approach is a different way to fix rectal prolapse compared to abdominal surgery. It goes through the perineum, the area between the anus and genitals. This method is good for people who can’t have abdominal surgery because of age or health issues.

Two main perineal surgeries for rectal prolapse are the Delorme and Altemeier procedures. Both aim to fix the prolapse by removing extra tissue. The right choice depends on how bad the prolapse is and the patient’s health.

Delorme Procedure

The Delorme procedure involves the following steps:

The Delorme procedure is less invasive and has fewer risks. But, it might not work for very severe cases.

Altemeier Procedure

The Altemeier procedure, also known as perineal rectosigmoidectomy, involves the following steps:

The Altemeier procedure is more complex and used for severe cases or when other treatments fail. It carries more risks but can offer lasting relief for many.

The perineal approach is a good option for those not suited for abdominal surgery. Knowing the differences between the Delorme and Altemeier procedures helps surgeons choose the best method for each patient. This ensures the best results.

Ventral Mesh Rectopexy: A Novel Technique

Ventral mesh rectopexy is a new way to treat rectal prolapse. It uses a mesh to support the rectum and stop future prolapse. This method aims to improve results and lower the chance of the problem coming back.

The surgery is done laparoscopically, which means small cuts and less pain. A mesh is placed and fixed to the front of the rectum. This creates a sling to keep the rectum in place.

This method is great because it fixes not just the prolapse but also other pelvic floor issues. It can fix problems like rectocele or enterocele at the same time. This makes it a more complete solution for those with rectal prolapse.

Many studies show good results with ventral mesh rectopexy. Patients often see big improvements in their life quality. They have fewer symptoms and better bowel function. But, like any surgery, there are risks and side effects to think about.

Rectal Mucosal Prolapse: A Special Consideration

Full-thickness rectal prolapse means the whole wall of the rectum bulges out through the anus. On the other hand, rectal mucosal prolapse only affects the inner lining of the rectum. This condition makes the inner lining of the rectum bulge out without affecting the muscle layers underneath.

Rectal mucosal prolapse shows similar symptoms to full-thickness prolapse. These include a visible bulge during bowel movements, mucus discharge, and feeling like you haven’t fully emptied your bowels. But, the bulge is usually less severe, and it might respond better to non-surgical treatments.

The table below compares the key features of rectal mucosal prolapse and full-thickness rectal prolapse:

For rectal mucosal prolapse, doctors might first suggest changes in diet, stool softeners, and exercises for the pelvic floor. If these don’t work, surgery might be needed. The Delorme operation or endoscopic mucosal resection can help by removing the extra mucosal tissue and fixing the anatomy.

Recovery and Postoperative Care after Rectopexy

After rectopexy surgery for rectal prolapse, it’s important to follow a proper recovery plan. Your healthcare team will guide you through this process. They will help you heal and support you every step of the way.

In the first days after surgery, managing pain is key. Your doctor will give you pain meds to help you feel better. As you heal, you’ll need less pain relief. Always tell your team if you’re feeling any pain.

Diet and Bowel Function

Right after surgery, you’ll only be able to have clear liquids. As you get better, you’ll start with soft foods and then move to regular ones. Drinking plenty of water and eating foods high in fiber can help with bowel movements. This is important to avoid constipation, which is common after surgery.

Activity Restrictions

After surgery, you’ll need to avoid hard work, heavy lifting, and sitting for long periods. Short walks are good to keep blood flowing and prevent problems. Your surgeon will tell you when you can start doing more things again.

It’s important to see your surgeon regularly after surgery. These visits help check on your healing and manage any issues. Following your doctor’s advice and talking openly with your team can make your recovery better.

Risks and Complications of Rectal Prolapse Surgery

Rectal prolapse surgery comes with risks and possible complications. While these are rare, it’s key for patients to know about them. Possible issues include bleeding, infection, damage to nearby organs, and reactions to anesthesia.

There’s also a chance the prolapse could come back. Modern surgery has lowered this risk, but it’s not gone. Choosing the right patient, using the best surgical methods, and good care after surgery are key to avoiding these risks.

Working closely with a skilled surgeon is vital to lower risks. Patients should share their health history, medications, and worries with their surgeon. Following post-surgery advice, like wound care and diet changes, helps avoid complications and aids in a smooth recovery.