When the lowest part of the bowel, the rectum, has become rather slack and when you strain, the lining of the rectum and finally the walls of the rectum pout out through the back passage (anus). Apart from the pouting bowel, many people have soiling and cannot control the wind. A rectal prolapse occurs when the normal supporting tissue of the rectum becomes weak, allowing the muscle to drop down through the anus. Sometimes this only happens when you open your bowels and goes back on its own. In more severe cases, the rectum may need to be pushed back after opening the bowels or may even stay outside all the time. While not a dangerous or life-threatening condition, this can be very uncomfortable, a considerable nuisance, and may cause loss of bowel control. There may also be a mucous or blood-stained discharge. When you and your surgeon have decided that your rectal prolapse is severe enough/troublesome enough to require surgical intervention, we perform a rectal prolapse repair.
This procedure aims to repair the prolapsed rectum by hitching the rectum up and stitching it to the inside of the pelvis so that it cannot prolapse out through the anus anymore. Usually a nylon mesh is placed on the rectum to help secure it. Sometimes the section of bowel above the rectum may have become very slack and elongated and may require removal. This procedure is mostly done laparoscopically (key-hole surgery).
- Bowel injury is possible, during the dissection, but is extremely rare, less than 1-2%.
- If you are having a segment of bowel removed and re-joined, a leak is possible. A leak is a major complication. This can take up to a week to declare itself, and you will be closely monitored during this period. This occurs in less than 5-10% of patients. It can be life-threatening, and you may require emergency re-look surgery to wash out leaked contents that can cause infection. It may be necessary to give you a temporary colostomy (formation of a stoma to bypass excretion from the injured area).
- Other risks include bowel blockage, a wound infection and bleeding.
- A late complication can be an incisional hernia, especially if there was infection in the wound and possible injury to the pipes that carry the urine from the kidneys to the bladder.
- Recurrence is reported, but in our own experience this is rare. If you were incontinent for faeces beforehand, you may notice an improvement. If constipated, a laxative may be necessary.
After your consultation:
- Obtain authorization from your medical aid and book your bed for your hospital admission.
- Carefully read through pre-operative information provided.
Day before surgery:
- Do not eat/drink after 22h00, the night before your surgery, unless otherwise specified by your surgeon or anaesthetist (you should be fasting for at least 6 hours before the procedure for solids but you are allowed to take clear liquids up to two hours before your procedure).
Day of surgery:
- Arrive for admission at indicated time on ‘Code & Consent’ sheet.
- Change into theatre attire, remove all valuable belongings.
Approximately 60-180 minutes.
Duration of hospital stay:
- 3-5 days (dependent on pain management, general state of patient and first bowel movement).
- Refrain from strenuous activities (incl. exercise) for at least 4 weeks post-operatively.
Back to work:
- Sick leave required post-operatively is approximately 10-14 days.
Some pain and discomfort post operatively may be expected following any operation, but the following measures are used to lessen the pain experienced:
- Warming devises in theatre as well as warm intravenous fluids.
- Intra-operative pain medication through the drip.
- Post-operative medication through the drip, please inform the nurses if you are in pain so that medication will be administered to you.
- As close to one week after discharge as possible. Please contact the rooms to schedule an appointment.