Rectal Prolapse
What is rectal prolapse?
Full thickness rectal prolapse occurs when all layers of your rectum (last segment of your large bowel before the anus) slips down, in a telescope-style, into the anal canal, and sometimes out the other side
Causes of rectal prolapse
Failure of the pelvic floor muscles that hold the rectum in place leads to rectal prolapse.
Many factors may contribute to this
Aging
Pregnancy and childbirth
Chronic constipation or diarrhoea
Spinal cord damage
Chronic coughing or sneezing
Symptoms of rectal prolapse
A feeling of pressure or a lump in your anus
A feeling of incomplete evacuation (as is something is left inside your anus after defecation)
Leakage or seepage of mucus, faeces or blood
Anal pain or discomfort
An actual lump hanging out of your anus
Who should manage your rectal prolapse?
A consultation with your GP and subsequent referral to a colorectal surgeon will ensure that your symptoms are appropriately assessed and treated
It is very important that the surgeon is familiar with all aspects of rectal prolapse and is skilled in the full range of available surgical techniques. Members of CSSANZ have these skills, and they are trained in the long term support and follow-up of patients who have surgery for rectal prolapse.
How is rectal prolapse managed?
The only definitive management of full thickness rectal prolapse is surgical repair
Investigations may involve:
Clinical examination to assess
The continuity and strength of anal sphincters
The presence of an enterocoele or rectocoele
Colonoscopy to exclude a lead point or another cause of rectal bleeding / mucus discharge / faecal incontinence
Anorectal manometer to measure the strength and tightness of your sphincters
MR or XR defecography to evaluate your muscles during defecation
Best surgical approach will be determined by the patients general health, history of constipation or faecal incontinence and previous abdominal or perineal surgery
Abdominal approaches: Laparoscopic / open mesh ventral rectopexy or suture rectopexy or resection rectopexy
Laparoscopic / open mesh ventral rectopexy is traditionally preferred in younger age patients and has a success rate of 97%
Resection rectopexy may be considered in patients with chronic constipation
Your rectum will be attached to the back wall of your pelvic (sacrum) with mesh / permanent sutures with or without partial bowel resection
Perineal approaches: Delormes or Altemeier procedure
This approach is traditionally preferred for elderly and high risk patients as it could be performed under regional (epidural) anaesthetic. This may also be a better choice if you have a very minor prolapse
Altimeter procedure : The prolapsed rectum is pulled out through the anus and removed
Delormes procedure: The prolapsed mucosal lining of the rectum is removed. The muscle wall of the rectum is then folded back onto itself and stitched together inside your anal canal.