A 64-year-old grandmother of three had suffered from symptoms of chronic constipation and faecal incontinence (leaky bowels) for about four years. The straining was so bad that her rectum had prolapsed, though she did not know it. Her husband complained there was an odour of stool about her. She became afraid of going out.

Worried, she went to Singapore General Hospital (SGH) where she met a specialist from the Pelvic Floor Disorders Service at SGH, a member of the SingHealth group. When less invasive treatment failed to have an impact, the specialist recommended surgery to insert a mesh into her pelvis that would hold up the rectum in its proper position. The operation changed her life.

The woman, who wanted to be known only as Madam S, said: “My quality of life has improved greatly. I don’t have to worry when I need to go to the toilet any more. I don’t strain any more and I don’t worry that I smell any more.” Though she suffered in private, she was not alone. One in 10 people are believed to live with chronic constipation. They strain to pass stools, feel as though something is blocking the flow and that they have not completely emptied their bowels afterwards.

Rectal Prolapse: Condition Worsens with Age  

Rectal prolapse is a problem that gets worse with age. And it is estimated that some 10 per cent of this group will suffer rectal prolapse serious enough to need surgery. In severe cases, the rectum falls out of the anus periodically.

But such patients may find relief with the surgical technique, ventral mesh rectopexy, used to treat serious cases of rectal prolapse. This procedure allows surgeons to restore the position of the rectum, with minimal side effects to the patient, through open surgery or by a laparoscopic (keyhole) approach through the belly.

"For suitable patients with rectal prolapse, ventral mesh rectopexy not only corrects the prolapse but has also been shown to provide significant relief of symptoms, including constipation, faecal incontinence and vaginal discomfort," said the specialist.

Rectal Prolapse: Symptoms

A rectal prolapse is a pelvic floor disorder characterised by a loss of support to the rectum so that it descends abnormally through the pelvic floor. In mild cases, the prolapse may not be obvious to the patient; a mild form can show up as a vaginal bulge. The loss of support is from the weakening of the pelvic floor muscles, usually because of the natural ageing process or an injury during the process of giving birth, particularly if forceps or vacuum suction had been used to pull the baby out. No studies have been done here on the incidence of this condition, but in the United States, the overall incidence of rectal prolapse is about 4.2 per 1,000 people.

Colorectal cases now make up more than half of the 50 cases seen at the Pelvic Floor Disorder Service at SGH. Among these, the percentage of patients with faecal incontinence has been steadily increasing from 25 per cent to almost 60 per cent in the last four years. Some patients come with combined problems, such as urinary incontinence and womb prolapse. Last year, the unit attended to 25 patients with complex rectal prolapse. Most of the patients with rectal prolapse are women – one man has it for every six women. As the prolapse worsens, patients may experience constipation and require excessive straining to pass stools, because of the lack of support.

Some patients, such as Madam S, may even have to resort to vaginal digitation, whereby they insert their fingers into the vagina to help empty their bowels. This is because, in her case, there is a weakening of the supporting tissues and the wall separating the rectum from the vagina, causing a vagina bulge. Patients also complain of “heaviness” in the pelvis, painful sexual intercourse or concurrent faecal incontinence, said Dr Wong. In the most severe form, the entire rectum protrudes out of the anus when the patient strains to pass stools, and this can lead to bleeding and pain over a period of time, and significant distress for the patient. But because of her operation, Madam S said she no longer strains to move her bowels, nor does she rely on vaginal digitation.

Read on to learn about treatments for rectal prolapse.

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