Rectal prolapse and perineal repair
A rectal prolapse is a when the last few inches of the bowel become stretched and stick out from the bottom (rectum or anus).
There is an increased risk of having a rectal prolapse from:
- vaginal childbirth
- long-term constipation
- heavy lifting
- weak pelvic floor muscles. These can weaken the tissue that supports the bowel, causing it to fall, or prolapse down
A rectal prolapse can be treated by surgery called a perineal repair (Delorme’s operation or Altemeier procedure).
During surgery, the lining of the bowel, or the section of bowel that has prolapsed, is removed and stitched back together. The surgery takes about 1 hour, and can be performed under a spinal or general anaesthetic.
Symptoms of a rectal prolapse
Your doctor might recommend perineal surgery, especially if you have these symptoms:
- bulging in the bowel or vagina
- pain and discomfort caused by the prolapse
- difficulty having a poo (opening your bowels)
- difficulty controlling your bowel movements, or you soil yourself without realising you needed the toilet
- discharge of mucus from the bottom
Risks of perineal repair surgery
Possible complications of any major surgery
There are problems that can happen while you are in hospital recovering from perineal surgery. These are similar to those for any major surgery, and include:
- bleeding, which might need a blood transfusion or more surgery in some cases
- injury to nearby nerves or tissues
- a chest infection
- blood clots in your lower leg (deep vein thrombosis or DVT), which could pass to your lung
- wound infection
- bruising around your wounds, poor wound healing or weakness at the wound sites
Risks of a perineal repair of rectal prolapse
There are risks that are specific to this type of surgery:
failure of the repair, resulting in another rectal prolapse
- bleeding from the bottom
- narrowing of the anal canal
- problems controlling your bowels (bowel incontinence), which might be temporary or permanent
- leak from the join in the rectum, this is the most severe complication and can be life threatening
Other treatment options
There are other treatment options for a rectal prolapse. The treatment decision is made depending on the type of prolapse you have, any previous surgery you have had and your medical health.
Techniques and exercises
A specialist nurse or physiotherapist can teach you a combination of correct techniques for going to the toilet, pelvic floor exercises and methods of emptying your bowels to avoid discomfort. This can prevent further prolapse or incontinence.
It might be possible to try rectal irrigation. This involves putting a tube or cone into your bottom and squirting up water. This allows the poo to be flushed out of your bowel. Your doctor or nurse let you know if this is appropriate for you, and you will be shown how to do this in the bowel function clinic.
Ventral mesh rectopexy
It is possible to repair the rectal prolapse through the tummy (abdominal) wall. This is called a ventral mesh rectopexy. Please discuss this option with your surgeon.
An abdominal approach involves repairing the prolapse by making a cut into the tummy.
Giving your permission (consent)
We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.
If you would like more information about our consent process, please speak to a member of staff caring for you.
Resource number: 4340/VER3
Last reviewed: April 2022
Next review: October 2023