Condition treated

The most important point to remember is that everyone with a bowel problem can be helped and many can be completely cured.
It is never too late to get help with your bowel problems. If you would like some advice on how to approach your GP regarding your bowel problem do get in touch.

Image of a patient rectum before a surgery. The full-thiknes rectal prolapse is being expose.

Rectal Prolapse

Full-thickness rectal prolapse is defined as protrusion of the full thickness of the rectal wall through the anus.

Backgound

The precise cause of rectal prolapse is not defined; however, as many as 50% of prolapse cases are caused by chronic straining with defecation and constipation. Peaks in occurrence are noted in the fourth and seventh decades of life, and most patients (80-90%) are women.

Rectal Prolapse

Full-thickness rectal prolapse is defined as protrusion of the full thickness of the rectal wall through the anus.

Backgound

The precise cause of rectal prolapse is not defined; however, as many as 50% of prolapse cases are caused by chronic straining with defecation and constipation. Peaks in occurrence are noted in the fourth and seventh decades of life, and most patients (80-90%) are women.

Image of a patient rectum before a surgery. The full-thiknes rectal prolapse is being expose.

Clinical presentation

Rectal prolapse is associated with:

A mass protruding through the anus, mostly during defaecation
Pain
Incontinence of faeces
Constipation

Treatment

In adult patients, treatment of rectal prolapse is essentially surgical; no specific medical treatment is available. Surgical treatments can be divided into two categories according to the approach used to repair the rectal prolapse: abdominal procedures and perineal procedures.

Abdominal procedures

On the whole, the abdominal procedures have a lower recurrence rate but a higher morbidity. Abdominal repairs are therefore generally performed in younger, healthier patients, whose life expectancy is longer.

Most abdominal procedures are currently performed laparoscopically or robotically:

Ventral mesh rectopexy is now the gold standard for the surgical treatment of rectal prolapse
Posterior mesh rectopexy is associated with higher rates of post-operative complications and is now rarely performed
Suture rectopexy avoids the use of a mesh but has higher recurrence rates.
Resection rectopexy is an option for patients with prolapse and severe constipation; it has the disadvantage that it introduces the risk of anastomotic leak and is associated with poor rectal fixation.

Perineal procedures

Perineal procedures are easier to perform but have high recurrence rates. Consequently, these are best reserved for older patients with significant co-morbidities and reduced life expectancy.

Perineal procedures for rectal prolapse are:

Anal encirclement; this is no longer commonly performed because of extremely high rates of recurrence and faecal impaction.
Delorme mucosal sleeve resection is often used for small prolapses.
Altemeier perineal rectosigmoidectomy removes a segment of rectum and colon and creates an anastomosis between the colon and anus; continence might be problematic post-operatively.