Rectal Prolapse Treatment: Conservative Treatment is the First Step

Rectal prolapse patients with chronic constipation are usually started on conservative treatment that includes dietary adjustments to moderate fibre intake, laxatives and specialised pelvic floor exercises called biofeedback therapy. If patients are no better after six months, some are offered surgical treatment.

This was what happened with 64-year-old Madam S, who was diagnosed with rectal prolapse by a specialist at the Pelvic Floor Disorders Service at Singapore General Hospital (SGH). Madam S had supervised biofeedback training for six months to strengthen and coordinate her pelvic floor muscles. But despite her best efforts, there was little improvement.

Rectal Prolapse Treatment: When Surgery is Required

Surgical procedures to treat rectal prolapse include Delorme’s operation, suture rectopexy and ventral mesh rectopexy. The recommended procedure depends on the individual patient. For instance, Delorme’s operation is usually recommended for those who are elderly and have other medical conditions.

Delorme’s operation is done through the anal canal where the prolapsed lining of the rectum is removed and the lining above is sutured back to the anal canal. Suture rectopexy is done via the abdomen where the prolapsed rectum is lifted up and then stitched against the spine.

In ventral mesh rectopexy (diagram shown below), the surgeon makes a single vertical incision below the belly button to access the rectum. Using laparoscopic surgery (keyhole surgery), four small punctures are made on the belly instead, which gives better cosmetic results.

According to a study on patients who underwent laparoscopic ventral mesh rectopexy, patients reported a significant decrease in vaginal discomfort and constipation symptoms. There were no new complaints of constipation, painful sexual intercourse or faecal incontinence (also known as leaky bowels). Most patients said their overall well-being improved.

 
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