Incontinence is the Most Incapacitating Complication After Treatment of Rectal Prolapse
Fecal incontinence is the most incapacitating complication after treatment of rectal prolapse, significantly impacting patients' quality of life and daily functioning. 1, 2
Complications After Rectal Prolapse Surgery
Surgical treatment of rectal prolapse can lead to several complications, with varying impacts on patient morbidity, mortality, and quality of life:
Incontinence
- Occurs in up to 23.1% of patients post-surgery 2
- Represents a significant quality of life impairment 1
- Can persist despite successful anatomical correction of prolapse
- More devastating to daily functioning than other complications due to:
- Social embarrassment
- Need for protective garments
- Restriction of activities
- Psychological impact
Constipation
- Common complication (25.6-43% of cases) 2
- Often worsens after rectopexy procedures 3
- Division of lateral ligaments during surgery is associated with higher rates of postoperative constipation 4
- While uncomfortable, generally more manageable than incontinence with dietary modifications and laxatives
Bleeding
- Less common than incontinence or constipation
- Usually self-limiting and temporary
- Rarely requires surgical intervention
- Primarily a short-term rather than long-term complication 4, 1
Risk Factors for Post-Surgical Incontinence
Several factors increase the risk of developing incontinence after rectal prolapse surgery:
- Pre-existing sphincter weakness
- Advanced age
- Female gender
- Type of surgical approach (perineal approaches may have higher incontinence rates)
- Addition of bowel resection in patients with pre-existing diarrhea 4
Prevention and Management Strategies
To minimize the risk of incontinence after rectal prolapse surgery:
- Careful patient selection for specific procedures based on pre-existing bowel habits
- Avoid bowel resection in patients with pre-existing diarrhea or incontinence 4
- Consider laparoscopic approaches when possible (associated with fewer complications) 4
- Implement biofeedback therapy post-operatively to improve pelvic floor function 1
- Provide adequate fiber intake and hydration to regulate bowel movements 1
Surgical Approach Selection to Minimize Complications
The choice of surgical approach significantly impacts complication rates:
- For younger, fit patients: Abdominal approach (laparoscopic when possible) with careful consideration of whether to include resection 1
- For elderly or high-risk patients: Perineal approaches (Delorme's or Altemeier's procedures) 1
- When constipation is predominant: Consider resection rectopexy 5
- When incontinence is predominant: Consider fixation rectopexy without resection 5
Conclusion
While all three complications (incontinence, constipation, and bleeding) can occur after treatment of rectal prolapse, incontinence represents the most incapacitating complication due to its profound impact on quality of life, social functioning, and psychological wellbeing. The PROSPER study and other research confirm substantial improvements in quality of life following proper surgical management, but incontinence remains the most challenging complication to address when it persists 1, 2.