Date issued: August 2022
Review date: August 2024
Ref: A-361 v3
What is a rectal prolapse?
A rectal prolapse is a condition which occurs when the last few inches of the rectum (or bowel), becomes stretched and protrudes from the bottom (anus).
What causes a rectal prolapse?
The pelvic floor supports the rectum and other organs in the pelvis. A weakness of the muscles results in prolapses of these organs. The pelvic floor can weaken due to having a vaginal childbirth, age, chronic constipation, heavy lifting and weak pelvic floor muscles all increase the risk of developing a rectal prolapse, as they can weaken the tissue that supports the rectum causing it to fall down. There are some young men and women who have a rectal prolapse because of weak body tissue (connective tissue disorder).
What is a perineal repair of rectal prolapse?
There are two ways to repair a rectal prolapse, either through the abdomen (tummy) or perineal (bottom/anus). A perineal repair is when the rectal prolapse is repaired from the bottom. Either the lining of the bowel (delormes) or section of the bowel (altemeiers) that has prolapsed is removed and stitched back together.
The altemeiers procedure is when the surgeon pulls the rectum through the anus, removes a portion of the lower bowel (rectum and sigmoid) and attaches the remaining bowel to the back passage. The decision whether it is perineal or abdominal is made on the type of prolapse you have, previous surgery performed and your medical fitness.
The delorme’s procedure is more typically done for short prolapses. The lining of the rectum is removed and the muscular layer folded to shorten the rectum. This repair is typically reserved for those who are not candidates for abdominal (open) or keyhole (laparoscopic) surgery. Both operations can take up to two hours, and can be performed under a spinal or general anaesthetic. A spinal anaesthetic is an injection into your back which numbs you from the waist down. This method is reserved for patients at high risk of a general anaesthetic.
If you have other prolapses such as a vaginal prolapse or pelvic organ prolapse, you might have both repairs done in one surgery by a bowel surgeon (colorectal) and a gynaecologist.
What are the risks?
Possible early complications
Bruising around the wounds, poor wound healing or weakness at the wound sites.
A chest infection.
Injury to nearby nerves or tissues.
Blood clots in your lower leg (deep vein thrombosis or DVT) which could pass to your lung.
Bleeding requiring the need for a blood transfusion or re-operation.
Specific risks of perineal repair of rectal prolapse
Failure of the repair, resulting in rectal prolapse recurrence which can occur in about 10%-30% of people.
Narrowing of the anal canal.
Constipation can worsen or become a problem when it was not before surgery.
Faecal incontinence, which may be temporary or permanent.
Bladder symptoms such as urinary frequency and/or incontinence.
Leak from the join in the rectum or missed perforation of the rectum. This is the most severe complication and can be life threatening (altemeier procedure). It can result in the need for an emergency operation and stoma formation.
What are the alternatives?
You can attend the pelvic floor clinic and be seen by a specialist nurse or physiotherapist. At these clinics you are taught a combination of correct toileting techniques, pelvic floor exercises and methods of emptying your bowels to avoid discomfort, and prevent further prolapse or episodes of incontinence. It may also be possible to try rectal irrigation. This involves inserting a tube into your bottom and squirting up water. This enables the faeces (stool) to be flushed out of your bowel in a controlled and planned fashion. However, you would be assessed if this is appropriate for you and shown how this is done properly in the Pelvic Floor Clinic.
You will spend a brief time in hospital recovering and regaining your bowel function. This will begin by drinking clear fluids and transition to solid foods. You will usually stay overnight, with your discharge planned for first thing the following morning.
What do I need to do after I go home?
You may need to continue to take your pain relief medicines and laxatives when you go home. A mild laxative is used to keep you from straining. You will need to take them until you are seen again in the clinic. If it makes you too loose and worsens your bowel control, you can reduce the laxative. Recovery will be different for everyone and can last anywhere from 4-6 weeks. You can resume normal activities as soon as you feel able to but should avoid straining, lifting and strenuous exercise for at least 6 weeks.
You may have rectal discharge or bleeding for up to 6 weeks after your operation, this is normal. We would advise that you purchase some panty liners for this, if you do not already have them. If you develop abdominal pain, the discharge becomes foul smelling or you have a temperature, please contact your doctor.
Do not take any rectal medications or enemas unless discussed with your surgeon, for at least 2 months after surgery. Please refrain from anal intercourse for 6 weeks, however vaginal intercourse can be resumed after 2 weeks.
If you have any questions either before or after your surgery, you can contact your consultants secretary. Alternatively, you can email your query to: