Rectal Prolapse Surgery in Ankara, Turkey

Rectal prolapse surgery aims to surgically correct the rectum that protrudes through the anus. The goals of treatment are to preserve bowel function, reduce the risk of recurrence, and improve quality of life. The surgical method is determined based on the patient’s age and overall health status.

After rectal prolapse surgery, regulating bowel movements is important. In particular, constipation control and dietary management increase treatment success. Postoperative follow-up plays a critical role in early detection of complications. With regular check-ups, the risk of recurrence can be reduced.

Laparoscopic rectal prolapse surgery is a minimally invasive method. Thanks to smaller incisions, recovery time is shorter, infection risk decreases, and patients can return to daily life faster. This method is especially preferred in younger individuals with good general health.

Techniques used in rectal prolapse surgery include abdominal and perineal approaches. The method is selected according to the surgeon’s experience, the patient’s age, and the presence of comorbidities. Individualized planning is of great importance for long-term treatment success.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Rectal Prolapse Surgery in Ankara, to get information about Rectal Prolapse Surgery prices, the process, and the hospital where Rectal Prolapse Surgery is performed.

What Is Rectal Prolapse?

Rectal prolapse is the condition in which the rectum (the last part of the large intestine) protrudes outward through the anus. It is commonly seen in older adults, after long-term constipation, or following childbirth-related trauma. In mild cases, only the mucosal layer protrudes; in advanced cases, the entire rectum can prolapse. Symptoms include fecal incontinence, pain, and a sensation of bulging. Treatment may require surgical intervention.

What Is Rectal Prolapse Surgery?

Rectal prolapse, in the simplest terms, is when the rectum slides out through the anus—much like turning a sock inside out. This happens because the supporting ligaments and pelvic floor muscles that normally hold the rectum in place gradually stretch and weaken. Rectal prolapse surgery is the procedure that corrects this anatomical problem by restoring the rectum to its proper position, securing it firmly, and relieving symptoms that negatively affect quality of life.

To understand the condition better, it helps to know that there are different types of prolapse. The three main types are:

• Full-thickness (external) prolapse
• Internal prolapse (intussusception)
• Mucosal prolapse

The most commonly recognized type is full-thickness prolapse, in which all layers of the rectum protrude completely through the anus. On examination, concentric circular folds are often seen—this is one of the key features that distinguishes it from hemorrhoids. Internal prolapse is a “hidden” form; the rectum does not protrude externally but folds into itself during straining, causing a persistent sensation of incomplete evacuation and blockage. Mucosal prolapse involves only the innermost lining of the rectum. Regardless of the type, the purpose of surgery is to correct the anatomy and restore normal rectal function.

When Is Rectal Prolapse Surgery Performed?

The decision to perform rectal prolapse surgery depends on how significantly the symptoms affect the patient’s daily life. The presence of a protruding tissue does not always require urgent surgery, but when it begins to impair quality of life, surgical treatment is considered. Common symptoms and situations that support the decision for surgery include:

• A noticeable mass protruding from the anus
• Pain, bleeding, or discharge related to the prolapsed tissue
• Involuntary gas or stool leakage
• Sensation of incomplete bowel emptying or blockage
• Severe constipation with a constant need to strain
• Needing to manually push the prolapse back in

If these symptoms are present, a comprehensive evaluation is performed to confirm the diagnosis and select the most appropriate treatment. The first step is a detailed medical history and physical examination. Sometimes the prolapse is not obvious during the examination; in that case, the patient may be asked to strain as if during a bowel movement so the prolapse can be observed.

Additional tests may be needed for definitive diagnosis and surgical planning:

• Colonoscopy: Especially in older patients, it is performed to rule out another cause such as polyps or tumors.
• Anorectal manometry: Measures the strength of anal sphincter muscles. It provides valuable information, particularly in patients with fecal incontinence, about functional recovery after surgery.
• Defecography: This test is like recording a “movie” of defecation. While the patient expels a contrast material, imaging (X-ray or MRI) captures pelvic floor dynamics. It can reveal not only rectal prolapse but also hidden herniations of the bladder or other bowel segments. It is the gold standard to confirm suspected internal prolapse and helps the surgeon choose the most appropriate repair technique.

After these evaluations, if the prolapse significantly reduces quality of life and surgery is expected to provide clear benefit, the operation is planned.

What Are the Risks of Rectal Prolapse Surgery?

As with any surgical procedure, rectal prolapse surgeries carry certain risks. Although modern surgical techniques and anesthesia have minimized these risks, it is important for patients to be informed. Risks vary depending on the type of surgery (abdominal or perineal), the patient’s age, and overall health.

General risks common to most surgeries include:

• Infection
• Bleeding
• Anesthesia-related complications
• Blood clots in the leg veins (deep vein thrombosis)

In addition to these, there are risks more specific to rectal prolapse surgery:

• Recurrence of the prolapse
• New-onset or worsened constipation
• Leakage at the bowel connection site (anastomotic leak)
• Mesh-related complications (if mesh is used)
• Persistence of fecal incontinence
• Sexual dysfunction (rare)

The most important and most discussed risk is recurrence. This risk is closely related to the chosen surgical technique. Abdominal procedures typically have a much lower recurrence rate (around 10%), while perineal procedures have a noticeably higher recurrence rate. Constipation risk was historically associated with injury to nerves behind the rectum in older abdominal techniques; however, nerve-sparing modern approaches have significantly reduced this risk. In procedures where a bowel segment is removed and reconnected (resection), anastomotic leak is rare but serious. Mesh procedures may very rarely lead to mesh erosion into adjacent organs or infection. In patients who already have advanced muscle or nerve damage, fecal incontinence may persist to some degree even if the anatomical repair is excellent. These risks are explained in detail by the surgeon based on the patient’s individual condition.

How Is Rectal Prolapse Surgery Performed?

The main decision in rectal prolapse treatment is which route to use: through the abdomen or through the anus (perineal route). Traditionally, more durable abdominal surgeries were recommended for younger and healthier patients, while less invasive perineal surgeries were preferred for older patients with significant comorbidities. However, the widespread use of laparoscopic and robotic techniques has changed this distinction. Many older patients can now safely undergo abdominal repairs with minimally invasive methods.

Abdominal Procedures

This approach is considered the “gold standard” because it minimizes recurrence risk. The basic principle is to enter the abdominal cavity, lift the rectum upward, and fix it to a strong point behind the pelvis (the sacrum). Today, these procedures are usually performed minimally invasively rather than with large incisions.

• Laparoscopic and Robotic Surgery: Performed through several small abdominal incisions using a camera and fine instruments. These methods provide results comparable to open surgery, with less pain, shorter hospital stay, and faster recovery.

Main fixation techniques used in abdominal surgery include:

• Suture rectopexy
• Ventral mesh rectopexy (VMR)
• Resection rectopexy

In suture rectopexy, the rectum is suspended to the sacrum using stitches without foreign material. Ventral mesh rectopexy (VMR) is one of the most modern and widely used techniques. In this method, important nerves on the back and sides of the rectum are preserved. A mesh is attached to the front of the rectum and then fixed to the sacrum, helping minimize postoperative constipation. Resection rectopexy is used when prolapse is accompanied by severe constipation due to an excessively long and slow sigmoid colon; the problematic segment is removed and the rectum is fixed in the same operation.

Perineal (Through-the-Anus) Procedures

These surgeries are performed entirely through the anus and leave no abdominal incisions. Because they put less physiological stress on the body, they are often ideal for frail, elderly patients or those with high anesthesia risk. The main disadvantage is a higher recurrence rate compared to abdominal procedures.

• Delorme Procedure: Best suited for shorter prolapses. The mucosal lining of the prolapsed segment is peeled off, and the underlying muscle layer is folded and sutured to shorten and strengthen the rectum.
• Altemeier Procedure: Used for larger, longer prolapses. The prolapsed rectum (and sometimes part of the sigmoid colon) is pulled out, removed, and the remaining bowel is reattached to the anal canal.

The choice of procedure is tailored to the patient (“custom-fit”), taking into account age, overall health, size of the prolapse, accompanying functional problems such as constipation, and the surgeon’s experience.

Recovery After Rectal Prolapse Surgery

After the surgery is successfully completed, a careful recovery period begins. This phase is critical for the repair to heal properly and become durable. Recovery speed varies depending on the surgical technique used and the patient’s overall health.

In the hospital, the process generally includes:

• A short hospital stay: Usually 2–4 days after minimally invasive abdominal surgery or perineal surgery.
• Pain control: Postoperative pain is typically well managed with effective pain medications. Pain tends to be milder after minimally invasive procedures.
• Gradual diet progression: Once bowel function begins to return, a liquid diet is started and then gradually advanced to solid foods.
• Early mobilization: Getting out of bed and taking short walks as soon as possible helps reduce clot risk and supports faster healing.

After discharge, home care is equally important. Your surgeon will provide individualized instructions, but the key general rule is to avoid straining. It may take some time for bowel function to fully normalize. Stool softeners should be taken as prescribed to keep stool soft. Be patient with physical activity: you can do light household tasks and short walks, but until your surgeon allows it (typically 4–6 weeks), avoid heavy lifting, strenuous exercise, and any activities that increase abdominal pressure. This period is necessary for the stitches and the repair to strengthen. Return-to-work timing depends on job type; desk work may be possible within a few weeks, while physically demanding jobs require a longer rest period.

What to Pay Attention to After Rectal Prolapse Surgery

Long-term success after rectal prolapse surgery largely depends on lifestyle habits. Surgery corrects the anatomical problem, but if underlying causes—especially chronic constipation and straining—continue, recurrence remains possible. Protecting the repair for life requires attention to a few key rules.

Diet Tips:

To keep stool soft and bowel movements easy, pay close attention to nutrition:

• Drink plenty of water (at least 2–2.5 liters per day).
• Include fresh fruits and vegetables daily.
• Choose high-fiber foods such as whole-grain bread, oats, and bulgur.
• Eat naturally laxative fruits such as prunes, apricots, and figs.
• Add legumes like chickpeas, lentils, and beans to your diet.
• Avoid refined flour products, excessive rice, and processed foods.

Lifestyle Recommendations:

Small daily changes can make a big difference:

• Never strain during bowel movements.
• Do not sit on the toilet for long periods (avoid spending time with phones, reading, etc.).
• Avoid heavy lifting strictly for the first 4–6 weeks after surgery.
• Even later, do not make heavy lifting a habit.
• Do light exercise regularly, such as brisk walking.
• Maintain a healthy weight, as excess weight puts additional strain on the pelvic floor.
• Use stool softeners as recommended by your surgeon.
• With your doctor’s approval, start pelvic floor strengthening exercises (Kegels).

When to Contact Your Doctor Urgently:

If you experience any of the following after discharge, contact your doctor immediately:

• High fever (38°C / 100.4°F or higher)
• Increasing abdominal or anal pain
• Foul-smelling or pus-like discharge from incisions
• Unexpected heavy bleeding from the anus or wound sites
• Nausea and vomiting
• Inability to pass gas or have a bowel movement

Following these recommendations is one of the most effective ways to protect the surgical result and help ensure this distressing problem is resolved long term.