What is a rectal prolapse?
This is a condition where the rectum comes out of the anal canal. There are varying amounts that can come out and sometimes most of the prolapse is within the rectum. Both men and women can get the problem at any age but it is most common in women as they age.
What is the cause of a prolapse?
The prolapse is due to a loss of attachment of the rectum to the sacral bone. It is also related to weakening of the pelvic floor as a result of childbirth. It can be caused by long term constipation and straining.
What are the symptoms?
Patients present with a lump at the anal canal. This is pink and there is usually some bright bleeding and passage of mucus. There is sometimes pain. The prolapse can cause faecal leakage (incontinence). The prolapse usually comes out during bowel movement and may need to be pushed back in.
Is it serious?
Prolapse usually needs surgery. If it can be pushed back in this is an elective (non urgent) condition. Occasionally the prolapsed cannot be pushed back into the anus and urgent intervention is required.
What is the treatment?
There are several operations for the treatment of rectal prolapsed. The procedure is selected based on the size of the prolapse, patient fitness and patient wishes. The operation is performed from the anus or through the abdomen either as an open or laparoscopic (key-hole) operation.
Operations through the abdomen involve fixing the rectum to the sacral bone. Sometime a part of the bowel needs to be removed. Operations through the anus require removal of the lining or the full thickness of the bowel.
Are the operations successful?
The various operations have different success rates. The lowest recurrence is with operations performed through the abdomen. The anal operations are less successful but generally more minor operations and are sometimes safer in elderly patients.
What are the complications of surgery?
The surgical procedures are safe with low complication rates. There are usually more complications if no operation is performed. There are specific complications related to the type of surgery and Dr Pathma-Nathan will discuss this.