Rectal Prolapse: Altemeier’s Procedure

This leaflet tells you how we aim to treat a rectal prolapse.

What is an Altemeier’s procedure?

It is a procedure to repair a rectal prolapse.

What is a rectal prolapse?

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

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

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 – a part of the intestine that folds into the section next to it.

This could have been caused by:

• age
• chronic constipation
• straining
• 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
• sensation of incomplete bowel motion
• faecal incontinence
• anal pain
• constipation
• rectal bleeding

How will the procedure benefit me?

You have been advised that you need surgery to repair your rectal prolapse. This is known as an Altemeier’s procedure. The aim of this procedure is to try to repair the prolapse by removing excess bowel and shortening the rectum to prevent it from happening again.

Are there any risks or possible complications?

These risks are applicable to any minor or major surgery:

• 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. 
• 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 and when you go home.
• Infection. This can be treated with a course of antibiotics and you may need a longer stay in hospital. 
• Incontinence. You may have some leakage of mucus or faeces after your operation, which can cause staining on your underwear. This is due to the gentle stretching of the anus (opening to the back passage) during the operation.
  This can last for a few weeks and usually needs no treatment. You could wear panty liners to help with this.
• Recurrence. If this happens, you may need further treatment or another operation.
• Injury to nearby organs, nerves or tissues. If this happens, you may need further treatment or another operation.
• Narrowing of the anal canal. 
• Faecal incontinence. This can be temporary or permanent.
• Leaking from the join in the rectum. This is rare. If this happens, you will need emergency surgery and a stoma (the opening made through the abdomen for the passage of faeces).

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?

Bowel preparation is very important before this operation so you might be asked to come in the day before or on the morning of the operation.

This will be given by either medication or 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 – 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.

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

The excess rectum is removed and then repaired (joined). This is done in the anus and no external cut is required.

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?

Your bowels will have been emptied before your operation. The feeling of not wanting to pass any bowel motion may last for a few days.

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.

You should avoid straining when trying to open your bowels. You may be given laxatives to help soften your stools and to stimulate (encourage) a bowel motion from the day of your operation.

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 passing a motion.

This can take up to 3 to 4 days after the operation. It is important to try to be 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 long will I need to be off work?

This may vary from 4 – 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.

You should try to avoid any lifting that may require straining. Most patients need 2 weeks off work, though every patient is different.

You should only do what you feel able to do and you must give your body time to heal. If you require a ‘Fit note’ for work, please let a member of staff know before you are discharged from hospital.

What to look out for when I am discharged?

When you go home, you must contact the Specialist Colorectal Nurse or seek medical help immediately if you notice any of the following:

• severe pain in the lower abdomen, rectum or lower back or lower back passage or lower back
• high temperature

• persistent nausea or vomiting

• persistent bleeding from the rectum

How can I help myself?

If you have trouble in controlling your motions or have problems with leakage, this may not improve straight away, so give it time. In some cases, exercises instructions are given and advice from a Specialist Colorectal Nurse to help with these symptoms.

To help prevent the prolapse returning you should:

• increase the amount of fluid you drink to at least 6 – 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.
• 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 to 8 weeks after the operation. If you haven’t 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.

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  

Day Case Unit  

Telephone: 01642 624168
Monday to Friday 8am to 5pm  

Specialist Colorectal Nurses  

Telephone: 01642 624399
Monday to Friday 9am to 4.30pm  

University Hospital of Hartlepool

Ward 9  

Telephone: 01429 382809
24 hours, 7 days a week  

Day Case Unit  

Telephone: 01429 522949
Monday to Friday 8am to 5pm  

Non-urgent messages can be left on the answering machine

For urgent advice within 2 weeks of discharge, outside of these hours, please contact the:

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

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

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Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

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Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]