Rectal Prolapse: Ventral Mesh Rectopexy

What is a rectal prolapse?

A rectal prolapse is when the last part of the rectum or bowel becomes stretched and protrudes (bulges) from the anus (bottom).

This can be caused by a weakness of the muscular pelvic floor and ligaments that support your rectum. Sometimes this only happens when your bowel is opened, and goes back itself afterwards. 

In more severe cases, the rectum may need to be pushed back in after your bowel has been opened, or may even stay outside all the time. 

There are 3 types of rectal prolapse:

• Full thickness – where the full thickness of the rectal wall has pushed through the anus.
• Mucosal prolapse – the rectal mucosa (not the entire wall) has pushed through from the anus.
• Internal prolapse (intussusception) – a part of the intestine that folds into the section next to it.

This could have been caused by:

• Age.
• Chronic constipation.
• Straining when having your bowels opened.
• Pregnancy or child birth.
• Poor bowel control.
• Neurological disorders, such as dementia.
• Weakness of the pelvic floor.

What are the symptoms of a rectal prolapse? 

Symptoms can include:

• Mucus discharge.
• Bulging on straining to have your bowels open.
• Sensation of incomplete bowel motion.
• Faecal incontinence.
• Anal pain.
• Constipation.
• Rectal bleeding.

What is a Ventral mesh rectopexy procedure?

It is a procedure to repair a rectal prolapse. In most cases this is performed as a laparoscopic (‘keyhole’) operation, which requires a small cut just below the navel (belly button) and 2 to 3 small cuts (each less than 1 cm) on the abdomen (belly). Occasionally, the operation needs to be performed as open surgery, which requires one long cut. Some surgeons use a robot to perform the surgery.

During the operation, the rectum is released from the back wall of the vagina (in women) or from the bladder and prostate (in men) and a mesh (a small sterile sheet of netting) is stitched to the front side of the rectum. The mesh may be made from body tissue (biological mesh) or from a non-natural material (synthetic mesh). The mesh is then fixed with special stitches to the bone at the back of the pelvis (the sacrum). This has the effect of pulling up the rectum to its correct place in the body and stopping it sliding downwards (prolapsing) again.

Are there any risks or possible complications?

• Bleeding. Bleeding from the operation site can happen for up to 1 week. If this bleeding continues and shows no signs of stopping you may need another operation to stop the bleeding.
• Recurrence. 1 in 5 for external rectal cases. 1 in 10 for external rectal prolapse. If this happens, you may need further treatment or another operation.
• Constipation. This may continue if you were constipated pre-op you may need to continue laxatives long-term. Your surgeon will discuss this with you before your surgery.
• Injury to nearby organs, nerves or tissues. If this happens, you may need further treatment or another operation.
• Risks associated with general anaesthetic. Your Anaesthetist (a doctor with special training in anaesthetics) will discuss this with you.
• Deep Vein Thrombosis – DVT (blood clots in the leg veins) or Pulmonary Embolism – PE (blood clots in the lungs). All adult patients will have their risk of developing a blood clot assessed within 12 hours of admission. Patients who are being admitted for planned surgery may have their risk assessed at a pre-assessment visit. The Nurse or Doctor who carries out the risk assessment will discuss your risk factors and advise on treatments to reduce your risk. You will also be given information on how to reduce your risk of developing a blood clot while you are in hospital.
• Erosion of the mesh (2 out of 100). The mesh may wear through the tissues over time and protrude through the wall of the bowel. This is called “erosion” and can occur many years after the mesh has been put in. Erosion may need complicated surgery to remove parts or all of the mesh.
• Discharge from the rectum or vagina. You may have some leakage of mucus or faeces after your operation, which can cause staining on your underwear. This should settle after a week or two.
• Infection. This can be treated with a course of antibiotics and you may need a longer stay in hospital. At the start of your operation, you will be given an antibiotic to reduce the risk of the mesh becoming infected.
• Dyspareunia (pain during intercourse). This is uncommon and usually gets better with time.
• Difficulty passing urine. You will have a catheter inserted whilst you are in the operating theatre, this is normally removed the following day.
• Urgency passing a stool (poo) and urination. This should settle over time.
• Faecal incontinence (unable to control when you poo). This can be temporary or permanent. Patients who have a weak anal sphincter may find exercises to strengthen the muscles can help.

What will happen at the pre-assessment clinic?

About 2 weeks before your operation, you will be sent an appointment to attend the pre-assessment clinic, unless you have already attended after your outpatient appointment.

You will be asked about your general health. Your blood pressure, pulse and weight will be checked. 

Please remember to bring a urine sample with you and all tablets, medicines, inhalers and creams you are using.  

Your Nurse will tell you if you need to stop taking any of these before your operation. Samples of your blood will be taken and you may be sent for an X-ray and ECG (a heart tracing).

What do I need to do before the operation?

You will be asked to come in to hospital on the morning of your operation.

You will be given an enema (medication to empty the bowel). This helps your Surgeon to be able to perform the surgery more effectively.

Routine blood tests may have been done in pre-assessment, but if not, they will be done before your operation.

You will be given some anti-embolism stockings ‘TED stockings’ to wear before, during and after the operation. This is to help prevent blood clots forming in your legs. 

After the operation, you may be given an injection every day for 4 to 6 weeks, which will also help to prevent clots after surgery.

Why am I asked not to eat or drink before my operation?

Your Nurse will tell you when you must stop eating or drinking before your procedure. This is very important.

You must follow the instructions.  Nothing means nothing at all. 

If you forget and you do eat or drink anything you must tell your doctor or Nurse, as your procedure may need to be postponed for your safety. 

This is because when you are unconscious, if your stomach contains food or drink, you may be sick and it could get into your lungs, affect your breathing and cause an infection.

What will happen during my operation?

Your Theatre Nurse will check your details again before taking you into the anaesthetic room. If your temperature is below 36°C (96.8°F), the procedure will not start until you are warm.  A warm air blanket or jacket may be used to raise your temperature.

When you are in the operating theatre and the recovery room, your Nurse will take your temperature regularly. If it falls below 36°C (96.8°F), you will be placed under a warm air blanket or jacket.

In the anaesthetic room, you will meet your Anaesthetist again. A cannula (fine needle) will be placed in the back of your hand or arm so we can inject medication. Sometimes, when medication is injected, it may feel cold and sting a little. 

An intravenous drip may be attached to your cannula. Your blood pressure will be measured. Your pulse will be taken, and the amount of oxygen in your blood will be measured by attaching a special clip to your finger. This does not hurt.

Your heart rate will be monitored by placing sticky pads on your chest. These are attached to some leads to show a tracing of your heart on a monitor. This is routine and it is nothing to worry about.

Your operation will be carried out under a general anaesthetic (a state of carefully controlled and supervised unconsciousness) or spinal anaesthetic, which means you are unable to feel any pain).

What will happen after the operation?

You will be taken to the recovery room. Specially trained Nursing Staff will look after you until you are ready to return to your ward.

You will return to the ward with a catheter (tube into your bladder) until you are able to pass urine without any discomfort. This is usually around 1 to 2 days.

If at any time you are in pain or feel sick, please let one of your Nurses know and they will give you medication to help relieve it.

You will have an intravenous drip in your hand or arm, through which you will receive fluids to prevent you from dehydrating until you are able to eat and drink normally again.

Patients are encouraged to keep mobile, within their ability, after the procedure.

You should avoid heavy lifting or increased physical activities for 6 weeks.

Will I be able to open my bowels?

From the day after your operation, you will be given laxatives to soften your stools and stimulate your bowel action. It is important that you take them as instructed for 6 weeks after your operation. You should avoid straining when trying to open your bowels.

You may experience a little discomfort and slight bleeding the first few times you empty your bowel. This is normal and can be expected. 

You may also pass some mucus from your anus for about 1 week. You may be advised to wear a pad to protect your clothing until these symptoms have settled down. 

How long will I be in hospital for?

Every patient is different and recovers at different speeds. We recommend that you stay in hospital until you are reasonably comfortable when having your bowels opened (having a poo). 

This can take up to 1 to 2 days after the operation. It is important to try to be as mobile as soon as you feel safe to do so.

Good hygiene is important to try to prevent any infection. You are able to take a shower the day after the procedure.

Will I have any sutures (stitches) to be removed?

No.  Any sutures used are internal.

How will I manage at home?

As with all operations you can expect some discomfort afterwards. We will give you painkillers to take home. Please take them regularly, doing so will keep the medicine at a constant level in your body and control your pain better. Always follow the instructions on the packet and never take more than the recommended dose.

It is very important not to take painkillers other than the ones you are sent home with. Some painkillers, e.g., opioids, can cause constipation. Your discomfort should disappear completely in a few weeks.

How long will I need to be off work?

This may vary from 4 to 8 weeks off after your operation, depending upon the type of work you do. You should ask your doctor or GP for advice.

If you are taking any medication that makes you drowsy, you must not drive or operate machinery. 

What to look out for when you are discharged?

When you go home, you must seek medical help immediately if you notice any of the following:

• Severe pain in the lower abdomen, rectum or lower back or back passage.
• High temperature.
• Persistent nausea or vomiting.
• Persistent bleeding from your rectum.

How can I help myself?

If you have trouble in controlling your bowel motions or have problems with leakage, this may not improve straight away, so give it time.

To help prevent the prolapse returning you should:

• Increase the amount of fluid you drink to at least 6 to 8 glasses a day. This can include water, tea, coffee, fruit juice or soup.
• Try not to become constipated. You may need to consider taking a fibre supplement, such as Fybogel to help prevent constipation.
• Avoid straining when having your bowels opened.
• Take special care not to become constipated if you become pregnant.

You should increase the amount of fibre in your diet gradually as a sudden increase can cause abdominal discomfort and wind.

Below are a few examples of the foods you could introduce into your diet:

• Wholemeal bread, pasta and rice.
• Beans.
• Lentils.
• Vegetables and fruit.
• Nuts.
• Seeds.
• High fibre cereals.

When can I drive again?

You can drive 2 weeks after the operation. However, you should not drive until you feel you are able to carry out an emergency stop.

You should check with your insurance company as policies may vary with individual companies.

When can I play sport again?

You should not go swimming until the area has healed. You should only do sporting activities if you feel you are up to it.

Will I have a follow-up appointment? 

You will have a follow-up appointment 6 months after your operation. If you have not received an appointment, please call the Outpatient Department or the ward which you were discharged from, they will be able to check this for you. 

Outpatient Department: 01642 383838

Contact numbers

If you have any worries or concerns during the first 24 hours following your discharge from hospital, please telephone the ward to which you were admitted. 

After 24 hours; please seek advice from your GP.

North Tees and Hartlepool NHS Foundation Trust

University Hospital of North Tees

Ward 28   

Telephone: 01642 382828   

24 hours a day, 7 days a week 

Ward 31   

Telephone: 01642 382831   

24 hours a day, 7 days a week  

Access Lounge

Telephone: 01642 624168   

Monday to Friday 8am to 5pm   

Surgical Decision Unit

Telephone: 01642 624566 

24 hours a day, 7 days a week.

Urgent Care Centre

24 hours a day, 7 days a week.

Either walk in or appointments via calling 111.

If you have any worries or concerns you should contact your GP during normal surgery hours.  Outside surgery hours you should contact your GP’s surgery for the Out of Hours Service number.

Further information is available from:

NHS Choices

Telephone: 111 (when it is less urgent than 999)

Calls to this number are free from landlines and mobile phones or via the website at www.nhs.uk

Bladder & Bowel Health – Bowel & Bladder UK. Website: https://www.bbuk.org.uk/adults/

The Pelvic Floor Society. Website:  https://thepelvicfloorsociety.org.uk/default.aspx

The National Institute for Health and Care Excellence (NICE)

Website: https://www.nice.org.uk/guidance/htg475

Patient Experience Team (PET)

North Tees and Hartlepool NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.

This service is based at the University Hospital of North Tees but also covers The University Hospital of Hartlepool, our community hospitals and community health services.

North Tees and Hartlepool NHS Foundation Trust
Telephone: 01642 624719
Freephone: 0800 092 0084
Email: [email protected]
Monday to Friday, 9:30 am to 4:00 pm

Out of Hours
If you wish to speak to a senior member of Trust staff, please contact the hospital switchboard (numbers below).