Rectal prolapse/ Laparoscopic Rectopexy in Mumbai, India

A “prolapse” is when and organ slips out or falls out from its original place. A “rectal prolapse” is the protrusion of rectum (the last part of the large intestine) out of the anal canal. Though it is not a medical emergency, it can be very unnerving and leads to an impaired quality of life and distress for the patient.

A prolapse could be “internal” when the wall of the rectum prolapses but does not protrude out of the anal canal. It could be “mucosal” where there is partial thickness protrusion of the mucosa (inner lining) of the rectum. This kind of prolapse can sometimes be confused with piles. Prolapse can be a full thickness protrusion of rectum outside the anal canal when it is called – “procidentia”.

Who is at risk for rectal prolapse:

• It is 6 times more common in women than in men. The incidence increases with advancing age and is the highest in women over 70 years.
• In men there is no relation to age. Usually, younger men are more predisposed to developing rectal prolapse.
• Though there is no clear-cut cause for rectal prolapse, it is seen to be associated with chronic constipation in many of the patients.
• Multiple child births through normal vaginal deliveries have also been implicated in the causation of rectal prolapse. However, almost a third of women with rectal prolapse do not give a history of vaginal delivery.

Signs and symptoms of rectal prolapse

• Patients with rectal prolapse present with tenesmus.
• They also complain of a sensation of tissue protruding out of the anus. It may or may not be possible to push the tissue back inside manually. Patients typically describe this as “something falling out” while passing stools. Until it is pushed back inside, it feels like they are sitting on a ball like structure.
• Some patients may complain of a sense of incomplete evacuation and may need to visit the washroom multiple times a day. Each visit to the washroom may lead to prolapse and can be very disconcerting and distressing for the patients.
• Sometimes the prolapse may be accompanied with mucus discharge from the anus.
• Fecal incontinence or constipation is seen in some cases.
• At times rectal prolapse may be confused with piles. Hence please visit a surgeon for proper evaluation if you have any of the above symptoms.
• Rarely the prolapsed mucosa may get ulcerated. It may also get incarcerated, which means that it is not possible to push it back into the anal canal. This condition can be acutely painful and may need emergency surgery.

Investigations

A careful history and clinical examination must be done.

• Colonic transit studies
• Ano-rectal manometry with defecography
• Colonoscopy
• Air contrast barium enema
• CT colonography
• Other routine investigations

Treatment of rectal prolapse

Primary treatment of rectal prolapse involves surgery. Surgery can be either through the abdomen or from below through the perineal approach.

Abdominal surgery has 3 main approaches. It is mainly performed laparoscopically. Considering that many patients who suffer with rectal prolapse are in the older age-group, laparoscopic surgery is very beneficial for them. It leads to much lesser trauma, less pain and an early recovery. The main surgical approaches are listed as under:

• Reduction of the perineal hernia and closure of the Cul-de-sac (Moschowitz repair)
• Fixation of the rectum with a prosthesis (mesh)- Ripstein and Wells rectopexy; or Suture rectopexy.
• Resection of sigmoid colon alongwith fixation of the rectum.

Abdominal rectopexy provides the most durable repair with recurrence rate of less than 10%. Perineal approach is preferred in high-risk patients who are unfit to undergo an abdominal surgery.

Anal encirclement procedures have now largely been abandoned.

Solitary rectal ulcer syndrome

Solitary rectal ulcer syndrome is commonly associated with internal prolapse. Patients present with pain, bleeding, mucus discharge or outlet obstruction. One or more ulcers are present on the anterior wall of the lower rectum. Most patients become better with non-surgical treatment. Surgery is advisable when all other treatment fails.

Cost of rectal prolapse in Mumbai

Cost of rectal prolapse surgery (Laparoscopic Rectopexy) varies from hospital to hospital. We are associated with multiple hospitals and believe that quality treatment must be accessible to all. Post your consultation we will guide you about the best possible option for your surgery.

Insurance coverage for rectal prolapse surgery in Mumbai

Rectal prolapse surgery (Laparoscopic Rectopexy) surgery is covered by health insurance.

Frequently asked questions

• Is rectal prolapse hereditary?

Genetic and familial predisposition plays some role in the development of rectal prolapse. Especially in women who have pelvic organ prolapse, genetic predisposition is said to play an important role.

• Is rectal prolapse common?

Rectal prolapse is common in older population and especially in women over 50.

• Is surgery the only treatment option for rectal prolapse?

Surgery in the form of laparoscopic rectopexy is the only “effective” treatment option for rectal prolapse. It leads to less than 10% recurrence rate.

• Is laparoscopic surgery safe for older patients?

With advances in anesthesia and laparoscopic techniques, surgery has now become much safer for older patients. Laparoscopic surgery helps patients to recover earlier with less pain.

• Can the prolapse recur?

Recurrence rate is higher after perineal approach for treatment of rectal prolapse. With abdominal approach the recurrence rate is less than 10% in experienced hands. However, every patient is different and responds differently to therapy.