Rectopexy is often performed when there is a protrusion of the rectum through the anus, known as a prolapse. In other words, the rectum at the end of the large intestine is no longer supported in its normal position within the body. It can fall or slide out of the anus. This surgery is also known as rectal prolapse surgery.
Although rectal prolapse is not life-threatening, it can certainly be life-altering as it causes many distressing symptoms. Over time, the condition may worsen. According to the American Society of Colorectal Surgeons (ASCRS), rectal prolapse is considered rare, with approximately 2.5 cases per 100,000 people reported.
Rectal prolapse typically occurs six times more often in people assigned female at birth over age 50 than in those assigned male at birth at the same age. However, anyone can develop rectal prolapse, regardless of their gender or age at birth.
the purpose
The main reason healthcare professionals perform rectopexy is to correct and repair rectal prolapse so it can function normally. There are three main types of rectal prolapse for which surgery is considered. This includes instances such as:
- The rectum is lowered from its normal position but remains within the anus.
- A portion of the rectum protrudes through the anal opening.
- The complete rectum has fallen outside the anus.
Treatment for rectal prolapse depends on the severity of the condition. If surgery is necessary, there are three different approaches to consider.
Three types of surgery for rectal prolapse
- abdominal rectopexy
- laparoscopic surgery
- perineal approach
The first is abdominal rectopexy, which involves entering the abdomen through a single incision and repairing prolapsed organs. The second approach, laparoscopic surgery, requires smaller incisions. The surgeon uses a camera and specially designed surgical instruments to correct rectal prolapse.
The third type, the perineal approach, enters the perianal area to treat rectal prolapse. All three procedures involve freeing the rectum from surrounding tissue and repositioning it in its proper location with sutures. In some cases, mesh may be used to support the rectum and hold it in place.
As mentioned in the article, there is currently no consensus on which approach is best. Journal of Minimal Access Surgery. Generally, most abdominal surgeries are performed laparoscopically. This is thought to lead to better outcomes and reduce the risk of recurrence.
The perineal approach may be used when abdominal surgery is not possible.
symptoms
However, to determine which surgery is right for you, your health care provider must consider factors such as your age, other health conditions, and the best way to relieve your symptoms. Symptoms for which rectopexy should be considered include:
- constipation
- Fecal leakage or fecal incontinence
- rectal bleeding
- mucus discharge
- pain in the rectum or anus
- Weakness of the muscles that support the rectum
- Other changes in bowel habits
Risk factor
Rectopexy is not a risk-free surgery and can lead to serious complications. Risks may vary depending on the type of procedure used and your personal medical history. People who are considered obese (BMI of 30 or higher) are more likely to experience complications, and health care providers may decide that some surgeries are safer than others.
However, it is important to note that most people recover normally after surgery. Here is a general list of risks associated with this operation:
- Infection
- Changes in bowel habits, such as increased constipation or diarrhea
- Recurrence of rectal prolapse
- pain
- bleeding
- intestinal obstruction
- intestinal incontinence
- Damage to organs, tissues, or nerves near the surgery
- occurrence of fistula
preparation
The day before your surgery, you may be asked to take medications, such as enemas or laxatives, to help flush out your intestines and any remaining stool in preparation for the surgery. This process is known as mechanical bowel preparation. Your health care provider may also instruct you to shower with soap that disinfects your skin to reduce the growth of microorganisms that can lead to infection.
You may also be asked to stop eating, drinking, and taking certain medications the night before your surgery. In some cases, you may be able to take important medications with a small amount of liquid. In addition, you may receive intravenous (IV) antibiotics immediately before surgery to further reduce the risk of infection.
After surgery
After your procedure, you will need to stay in the hospital for at least one day so that your medical team can monitor your progress, watch for signs of infection, give you pain medication, and assess your bowel function.
You may be asked to increase your fluid intake and follow a special diet, such as eating soft foods and foods rich in fiber, to prevent constipation. When you are discharged from the hospital and go home, you will be given a post-operative appointment to check on your recovery.
Patients usually recover from rectopexy within 4 to 6 weeks.
prognosis
In most cases, surgery is performed to relieve symptoms of rectal prolapse. Rectal prolapse occurs again in approximately 2 to 5 percent of people who have surgery. Additionally, some people may experience changes in their bowel habits.
For example, some patients may develop new constipation after surgery. If you develop new symptoms, talk to your health care provider to discuss new ways to reduce discomfort.
A word from Berrywell
Once you are discharged from the hospital, you will be provided with instructions to gradually increase your activity level. You may be asked to walk in a low-impact manner to use your muscles and increase blood circulation. If you have weak tone in the pelvic floor muscles that hold your rectum in place, your health care provider may recommend seeing a physical therapist. As with any procedure, if you have any questions or concerns, be sure to discuss them with your practitioner to help you get back to your daily routine.