While partial or mucosal rectal prolapse and internal intussuception can be treated non-surgically, complete rectal prolapse generally requires surgical treatment. Surgery can be done either abdominally or via the anus. There are a range of options for surgery that your surgeon will select based on your age, health and the extent of the prolapse and associated intestinal issues.
The most common procedures support the rectum by suturing or otherwise attaching it to the tissues surrounding the sacrum (the fused spinal bones just above the tailbone). Resection of the bowel may also be used to reduce the amount of excess tissue that can protrude. In patients for whom abdominal surgery is not an option, some of these procedures can be done via the anus. There is also the option of installing a support for the anus to prevent the rectum from sliding out, but this is usually only used for the oldest and least healthy patients. Younger patients are more able to tolerate abdominal procedures, which have the lowest risk or recurrence.
Other pelvic conditions including colon problems, other organ prolapses and cystoceles may be treated at the same time as the rectal prolapse surgery. Your doctor may do tests before surgery for rectal prolapse to determine if you have other conditions that should be treated concurrently.
Abdominal procedures are usually done laparoscopically, which requires only small incisions to insert tools and a camera. Recovery depends on your exact procedure. Most patients can expect to spend at least a day or two in the hospital, and approximately 5 days is typical. Once at home, you will want to rest and have help with your household activities for up to several weeks. If bowel resection was a component, you will be on a low-residue diet for the first couple weeks. Perianal procedures require 1-3 days of hospitalization and recovery is rapid since there is no incision.
Potential complications of rectal prolapse surgery include bleeding, infection and injury to the surrounding organs. Recurrence of the prolapse is not uncommon and varies depending on the cause of the prolapse and the type of repair used. Appropriate use of fiber and stool softeners to reduce straining can reduce the risk of recurrence.