The pelvic floor consists of a group of muscles and connective tissues that provide support to the pelvic organs (uterus, bladder and rectum) so that these organs can function appropriately.
Pelvic floor disorders occur when the pelvic floor is weakened or injured.
This can occur due to vaginal delivery, menopause, excessive straining from prolonged cough, constipation and presence of mass in the pelvis.
Symptoms may vary from individual to individual. Some of the common symptoms are:
- Heavy, dragging sensation
- Lump that can be felt or seen at the vagina
- Urinary difficulties (e.g. incomplete emptying of the bladder)
- Bowel difficulties (e.g. constipation, incomplete emptying of bowels)
Many people may not require treatment. Some cases can be managed with modifications in diet and lifestyle. Treatment options include medication, use of a device called pessary to support the pelvic organs, and surgery.
Pelvic floor exercises (Kegel exercises) can help strengthen the muscles around the openings of the urethra, vagina and rectum. Treatment of incontinence includes medication and bladder or bowel control training.
If pelvic floor dysfunction is the result of a rectal prolapse or rectocele, surgery may be indicated. A rectal prolapse occurs when tissue that lines the rectum falls or prolapses into the anal opening. In women, a rectocele occurs when the end of the rectum pushes through the wall of the vagina.
Rectal prolapse occurs when the rectum becomes stretched out and protrudes from the anus.
Rectal prolapse surgery can be done through the abdomen (rectopexy) — either with a large incision (open surgery) or laparoscopic methods — or through the region around the anus (perineum).
The surgery might be done with general anaesthesia, in which you’re asleep; a spinal block, in which your lower half is numb; or a combination of relaxing medication and local anaesthesia to numb your anus (perianal block).
Which approach your surgeon uses depends on a number of factors, such as your age, your other health problems, your surgeon’s experience and preferences, and equipment available. No procedure is considered the best overall. Discuss your options with your surgeon.
Types of rectal prolapse surgery:
- Rectal prolapse repair through the abdomen.Using an incision in the abdomen, the surgeon pulls the rectum back in place. Using sutures or a mesh sling, the rectum is anchored to the back wall of the pelvis (sacrum). In some cases, such as a long history of constipation, the surgeon removes a portion of the colon.
- Laparoscopic rectal prolapse surgery.This procedure uses several smaller incisions on the abdomen. The surgeon inserts special surgical tools and a small camera through the abdominal incisions to repair the rectal prolapse.
- Rectal prolapse repair throughthe area around the anus (perineal rectosigmoidectomy). During the more commonly performed form of this procedure (Altemeier procedure), the surgeon pulls the rectum through the anus, removes a portion of the rectum and sigmoid colon and attaches the remaining rectum to the large intestine (colon). This repair is typically reserved for those who are not candidates for open or laparoscopic repair.
Another method for repairing a rectal prolapse through the perineum (Delorme procedure) is more typically done for short prolapses. The lining of the rectum is removed and the muscular layer folded to shorten the rectum.
If you have rectal prolapse and certain other conditions, such as vaginal prolapse or pelvic organ prolapse, you might have both repairs done in one surgery.
You’ll spend a brief time in the hospital recovering and regaining your bowel function. You’ll begin by drinking clear liquids and transition to solid foods. The amount of time you spend in the hospital will depend on which procedure you have.
Your doctor is likely to recommend drinking lots of fluids, using stool softeners and eating a fibre-rich diet in the weeks after surgery to avoid constipation and excessive straining that can lead to recurrence of the rectal prolapse. Most people are able to return to normal activities within four to six weeks after surgery.
Some people require physical therapy to relearn how to use the pelvic floor muscles.
For most people, rectal prolapse surgery relieves symptoms and improves faecal incontinence and constipation. However, in some cases, constipation can worsen or become a problem when it wasn’t one before surgery. If you have constipation before surgery, talk to your doctor about ways to relieve it.
Recurrence of rectal prolapse after surgery occurs in about 2 to 5 percent of people. It appears to be slightly more common in people who have the perineal procedure compared with an abdominal one.