Rectal Prolapse Treatment - Diagnosis, Surgery & Recovery

Rectal Prolapse Grading

Who is at risk of developing rectal prolapse?

Rectal prolapse is more likely to happen to someone who has any of the following:

• Individuals above the age of 50
• Constipation for a long time
• Straining during bowel movements
• Chronic diarrhea
• Laxatives abuse
• Child birth
• Issues with the spinal cord or a previous stroke
• Cystic fibrosis
• Dementia

Diagnosis

Your doctor will examine your symptoms and medical history and perform the following diagnostic tests. 

• Digital rectal examination: To assess the strength of your sphincter muscles and check for any issues in the rectal area, your doctor inserts a gloved, lubricated finger into your rectum.  He may ask you to bear down during the exam to check for rectal prolapse.
• Defecography: Defecography can help determine how your rectal muscles are functioning and reveal structural abnormalities in and around your lower digestive tract.
• Anal manometry: Your doctor inserts a narrow flexible tube inside the anus and rectum. A tiny balloon may be blown up near the tip of the tube. This test assesses the function of your rectum and the tightness of your anal sphincter.
• Colonoscopy:  Colonoscopy is done to rule out other diseases, including hemorrhoids, polyps, or colon cancer. A flexible tube is inserted into your rectum to view the whole colon during this surgery. 
• Barium enema:  Before taking the X-ray images, a chalky contrast solution is inserted into the rectum.
• MRI:  During a simulated bowel movement, a specialised MRI can be done.
• Specific gynecologic or urologic assessments:  Your doctor will also examine the rest of your pelvic floor. He will check for signs of weakening or prolapsed organs(could be the uterus or bladder). The doctor may also recommend this test when a woman has both uterine and rectal prolapse.

Rectal prolapse surgery

Before surgery for rectal prolapse

• You may need to drink a specific liquid, which will help clear the intestines.
• Your doctor will ask you to fast the day before the operation.
• The anesthetist will come to see you once you’re in the hospital to determine what kind of anesthetic is best for you.
• To induce drowsiness and prepare you for anesthesia, you might get medicine in the hours before the procedure.

Rectal prolapse surgery procedure

The various types of rectal prolapse treatment surgery include:

• Open abdominal surgery: The surgeon makes a single, large abdominal incision to pull the rectum back in place. After that, the surgeon carefully removes the overlying organs. The rectum is elevated, pulled straight, and sewn directly to the inner surface of the sacrum, the primary bone of the pelvis, to prevent it from prolapsing. Sometimes, a small section of the colon may be removed.
• Laparoscopy: The doctor makes several tiny incisions in the abdomen. Through the incisions, surgical tools and a tiny camera is inserted to repair the rectal prolapse. After the laparoscopy, recovery is usually faster than after an open procedure.
• Robotic surgery: The procedure is similar to the laparoscopic approach, but uses the assistance of a surgical approach.
• Anal surgery:  The surgeon removes the prolapsed bowel through the anus while the patient is under general anaesthesia. Usually, the prolapsed bowel segment is excised, and the structural damage is fixed. To restore normal bowel function and appearance, the bowel is reconnected and returned through the anus.

Delorme procedure. The procedure includes folding and sewing a portion of the rectal wall to itself to reinforce weak or damaged tissue. The patient will experience an improved bowel movement and decreased risk of recurrence after the surgery. During the procedure, the doctor will insert a proctoscope into the rectum to visualize the prolapse. The prolapsed tissue is then removed, using a scalpel or scissors and the edges of the remaining rectal tissue are sutured.

After the surgery

• Your temperature, pulse, breathing, and blood pressure will be monitored by the hospital staff.
• You may have to stay in the hospital until you regain bowel function 
• The doctor will ask you to drink lots of fluids, eat a fibre-rich diet, and use stool softeners. It will help to address constipation and excessive straining.
• Depending on your condition, the doctor may give you some painkillers.
• For the next day after the surgery or until you can empty your bladder on your own, you might have a catheter to drain urine.
• You will have to schedule follow-up visits with your doctor.

Complications || What happens if rectal prolapse is left untreated?

You might be able to manage rectal prolapse at home for a while if the symptoms aren’t too severe.  To take care of it, you must manually push your rectum back inside. The doctor may advise you to lie on your side with your legs close to your chest and gently press your rectum back into position using a warm, damp towel. Prolapse will, however, get worse over time.

Rectal prolapse that is left untreated may cause several issues, such as:

• Fecal incontinence:  You could find it harder to hold in gas and poop as your anal muscles continue to stretch. Fifty to seventy-five per cent of individuals with rectal prolapse experience this problem.
• Constipation: You may have trouble emptying your stool due to rectal bunching and issues with muscle coordination. 
• Rectal ulcers: The friction and exposure of your rectum’s mucus lining may cause rectal ulcers and painful bleeding sores. Uncontrolled bleeding may also lead to anaemia.
• Incarceration:  When a rectum becomes incarcerated, it becomes trapped hanging out of your anus and cannot be forced back in. This poses the risk of strangulation, or cutting off the blood supply. It may also cause the death of tissues and rectal decay(gangrene).