Chronic Constipation after Rectopexy

By Dr. Julia Lizy, MBBS (KEMU)

Chronic constipation after rectopexy

Rectopexy

This surgical procedure is done to correct rectal prolapse, a condition in which the rectum falls from its normal anatomical position. It is caused by the weakening of surrounding supporting tissues.

Factors causing rectal prolapse are:

• Advancing age
  
  
• Repeated childbirth
  
  
• Constipation
  
  
• A hysterectomy
  
  
• Heavy lifting
  
  
• Straining on defecation
  
  
• A chronic cough

Rectopexy is the procedure which is used to correct rectal prolapse.

This is done by going in through the abdomen, either by laparotomy or laparoscopy. In this procedure, the rectum is separated from surrounding tissue.

The sides of rectum are lifted and then sutured to secure it in place. There are three types of Rectopexy:

1. Mesh Rectopexy
   
   
2. Suture Rectopexy
   
   
3. Resection Rectopexy

Using Rectopexy to correct rectal prolapse is considered effective, with the majority of patients reporting complete relief of rectal prolapse symptoms.

Problems after Rectopexy

Rectal prolapse is a serious problem that needs to be corrected.

When Rectopexy is selected to correct rectal prolapse, there are many post op problems that may occur. The most common of these is chronic constipation.
  
Constipation complaints vary among various people according to degree of prolapse, type of Rectopexy performed, cause of rectal prolapse and age of the person.

If constipation is a problem prior to surgery and the main cause of the rectal prolapse, then constipation is going to be worse after Rectopexy.

Once Rectopexy has been performed, the surgery should be carefully followed up to ensure the chronic constipation after Rectopexy is not a problem.

Why Chronic Constipation After Rectopexy?

The cause of chronic constipation after Rectopexy can be divided into following:

It is due to an existing constipation

If constipation exists before Rectopexy, there is a good chance that it will get worse after the procedure. The reason is that Rectopexy causes a further narrowing of the rectum.

It is due to the procedure

Some individuals who don’t have a problem with constipation before Rectopexy can discover this complication after surgery. Rectopexy generally causes a narrowing of rectum.

This is caused by the mesh material or suture material that has been wrapped around the rectum to keep it in position. To prevent this obstruction, mesh is only be placed posterior to rectum.

In spite of this practice, adhesions can still occur, causing an obstruction. This may lead to a severe constipation problem.

Resection Rectopexy is a procedure in which a part of sigmoid colon is removed, and then suture is used to secure the rectum to the sacrum. Sometimes the resulting constipation problem can be so annoying as to necessitate the removal of the suture attaching the rectum to the sacrum.

It is due to inappropriate post-op care

Post-op care is very important following Rectopexy. A proper post-op care plan should be made to avoid Rectopexy complications.

Failure to do this can result in chronic constipation after Rectopexy, along with other complications.

How to Avoid Chronic Constipation After Rectopexy

Here is some information that may be helpful in avoiding chronic constipation after Rectopexy.

Get a thorough pre-op evaluation

There should be a complete evaluation of symptoms before surgery.

The degree of prolapse, type of prolapse, associated problems such as rectal bleeding and constipation, and other patient related risk factors should be documented thoroughly.

If there is no such evaluation and the patient is already suffering from constipation before the surgery, the straining from constipation may actually be the main cause of the rectal prolapse.

In some cases of rectal prolapse caused by constipation, employing a magnesium supplement regimen to reduce or eliminate straining might help to reverse the prolapse.

When straining is eliminated, it allows the body to try and heal itself.
As mentioned before, Rectopexy can worsen constipation symptoms.

Therefore, if a person is battling with constipation before Rectopexy surgery, it is best to get it under control before undergoing surgery.

Constipation due to Rectopexy

Constipation may occur as a result of a Rectopexy operation, due largely to faulty technique or operation an operation done by inexperienced doctor.

To avoid post surgery constipation, the mesh or suture material should only be placed laterally and posterior to the rectum. Circumferential wrapping of sutures may cause an obstruction in the rectum, leading to constipation.

If Rectopexy is not done properly, there may be adhesion formation after surgery, resulting in an obstruction of stool passage through the rectum. An experienced surgeon should be able to prevent this.

An alternative to abdominal Rectopexy

A good substitute of abdominal Rectopexy is Laparoscopic Rectopexy.

This procedure is less painful and requires less time for recovery. Laparoscopic Rectopexy avoids the problem of extensive adhesion formation, lessening the complication of constipation after surgery.

Laparoscopic Rectopexy should be performed by an experienced surgeon.

Post operative care

Once Rectopexy has been performed, proper post operative care is very important to avoid complications.

Post op care includes following:

• A Foley catheter may remain in place one to two days after surgery.
  
  
• Patient will receive a liquid diet until the return of normal bowel function.
  
  
• Patient is asked to avoid all activities which increase the pressure in rectal area such as straining and heavy lifting.
  
  
• If the patient has a persistent cough, the doctor should be consulted for an effective treatment.
  
  
• Smoking should be avoided
  
  
• With complete and proper aftercare, the prognosis is good. It takes four to six weeks for complete recovery.
  
  

In case of constipation post operatively

If the patient experiences constipation after Rectopexy, the following measures should be carried out.

• The patient should stay on a liquid diet, which may include items like yogurt and custard.
  
  
• Keep an close eye on bowel movements until they return to normal.
  
  
• Consult your doctor if you experience any problems.
  
  
• Modify your diet to avoid straining during defecation, as straining can lead to a relapse of rectal prolapse.
  
  

Dietary modifications to avoid constipation

• Eat at least five serving of fruits and vegetables every day. These are high in fiber, a necessary part of a constipation free diet.
  
  
• To stay hydrated, drink plenty of water, at least six to eight glasses a day.
  
  
• If you are not getting 20 to 35 grams of fiber a day, consider taking a daily fiber supplement. Start with small doses and slowly increase the dose over a 4 week period.
  
  
• Laxatives can be used in moderation upon the advice of your doctor. Most commonly, bulk forming laxatives are advised.
  
  
• Have a scheduled time each day for a bowel movement. When your body adapts to this routine, it will help you to avoid straining.
  
  
• Magnesium helps to maintain the moisture level of stool. However, 80% of Americans don’t get enough magnesium in their diet. A magnesium supplement may be the key to avoiding chronic constipation after Rectopexy.
  
  

The role of magnesium

Magnesium is a laxative mineral that acts in two ways.

• It relaxes colon muscles, helping to relieve constipation by maintaining a smooth rhythmic peristaltic movement of the colon.
  
  
• It draws water into the colon. This helps moisten and soften stools, making them slippery. The added water means the stool is bulkier, which is nature’s way of stimulating the peristaltic movement of the colon.
  
  

Conclusion:

Rectopexy is a relatively safe procedure.

Most people recover completely if:

• A proper pre-op evaluation is done
  
  
• The procedure is done with caution
  
  
• Proper post-op care is maintained

When these are done, there are seldom any complications.

Chronic constipation after Rectopexy can be easily controlled by the dietary modifications mentioned above, and by use of a laxative when needed.

A magnesium supplement is a wonderful tool for treating chronic constipation after Rectopexy.

Taking a magnesium supplement may result in other health benefits as well.

(Return from Chronic Constipation After Rectopexy to Causes of Constipation)