Skip to main contentAhmedabad and Gandhinagar · Dr Harsh Shah, Rectal & Pelvic Floor Surgeon
Rectal prolapse surgery fixes the anatomy. It does not reliably restore control of the bowels, and any surgeon who promises that is overselling the operation. Control improves in many patients and in some it does not improve at all, and it cannot be predicted in advance which group a person will fall into. The operation itself is chosen from fitness, from bowel habit and from whether mesh is appropriate at all — an abdominal rectopexy for the fitter patient, a perineal repair for the frail or for an emergency, and a resection rectopexy where severe constipation and a redundant sigmoid sit alongside the prolapse.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Rectal & Pelvic Floor Surgeon
· Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Qualified twice over in surgical gastroenterology. Rectal prolapse is a condition where the operation is the easy part and the selection is the hard part, which is why Dr Harsh Shah assesses the pelvic floor as a whole before naming a procedure — the sphincter, the bowel habit, the other compartments, and the patient’s own fitness. Google rating 4.89 from 216 reviews at the Gota listing, and 4.94 from 17 reviews at the Apollo, Bhat listing.
Please note: haemorrhoids (piles), anal fissure and perianal fistula are not treated in this practice and are referred on. They matter here only because they are the commonest things mistaken for a prolapse, and telling them apart is part of the first examination.
A full-thickness rectal prolapse shows concentric rings of bowel wall with a groove between the prolapse and the anal opening. Prolapsing piles show radial folds and involve the lining only. The two are treated in completely different places, and the distinction is made by looking, not by history.
What brings people in is nearly always the same sentence: something comes out when I go to the toilet. At first it goes back on its own, then it has to be pushed back, and eventually it stays out. Three other complaints matter as much as the lump — leakage, a bowel that never feels empty, and mucus or bleeding from the exposed lining.
| What is seen | Full-thickness rectal prolapse | Mucosal prolapse or prolapsing piles |
|---|---|---|
| Pattern of the folds | Concentric, ring upon ring | Radial, like spokes |
| Thickness | The whole bowel wall, with a groove between it and the anal verge | Lining only |
| Where it is treated | Here — this page | Referred on; not treated in this practice |
One practical point decides whether the diagnosis is made at all. A prolapse frequently refuses to appear while a patient lies on the examination couch, and “no prolapse found” written in a clinic letter is one of the commonest false reassurances in this condition. The patient is therefore examined straining, on a commode where possible. If a previous clinic could not find the prolapse you describe, that is a reason to be examined again properly, not a reason to accept that nothing is wrong.
Every adult with a rectal prolapse has a colonoscopy before any planned operation. A prolapse can be dragged down by a growth acting as a lead point, and operating on a prolapse without having cleared the colon is an avoidable error rather than an unlucky one.
Beyond the colonoscopy, the tests are chosen to answer specific questions rather than ordered as a panel.
| Test | What it settles |
|---|---|
| Colonoscopy | Excludes a growth acting as a lead point and any coexisting disease in the colon. Mandatory in every adult before elective surgery. |
| Defaecating proctography or MR defaecography | Shows what happens during evacuation — internal intussusception that never reaches the outside, rectocele, enterocele, and how far the perineum descends. It is what separates an internal prolapse from an external one. |
| Anorectal manometry and endoanal ultrasound | Measures the sphincter and shows whether it is torn or simply weak. Particularly important where leakage is the main complaint, and in women after childbirth injury. |
| Colonic transit study | Used where constipation is severe. A slow-transit colon with a long redundant sigmoid changes the operation from a plain rectopexy to a resection rectopexy. |
| Assessment of the other compartments | Vaginal and bladder prolapse sit alongside rectal prolapse often enough that all three are assessed together, with gynaecology involved where more than one compartment is affected. |
Where more than one compartment is involved, or where mesh is being considered, the case is discussed at a joint pelvic floor meeting before anything irreversible is offered. Fixing a rectal prolapse in isolation in a woman with significant vaginal prolapse is poor planning, not efficient surgery.
An internal prolapse that never reaches the outside, obstructed defaecation and solitary rectal ulcer syndrome are treated without surgery first, and usually only with surgery if that has genuinely failed. Specialist pelvic floor physiotherapy with biofeedback is the single most valuable non-surgical treatment in this condition, and it is the one most often never offered.
This is not a holding measure while a date is found. It is treatment, and for a large group of patients it is the whole treatment. Stool is softened so straining stops, because straining produced the problem and will pull a repair apart afterwards; constipating medicines are reviewed and changed; and where leakage dominates, bulking agents with carefully titrated loperamide often do more than an operation would. Transanal irrigation — emptying the lower bowel on a schedule with warm water — works for both obstructed evacuation and leakage and is badly under-used here. Physiotherapy deserves its own sentence: a pelvic floor that contracts when it should relax cannot be fixed by fixing the rectum, and biofeedback retrains exactly that. It is started before surgery and continued afterwards.
A prolapse that has come out and will not go back is different: that is urgent. Pain relief and steady, sustained gentle pressure will reduce most of them. Ordinary granulated sugar sprinkled on the swollen lining draws out the fluid and often allows a prolapse to be reduced that otherwise could not be — a simple manoeuvre that too few people know. If it still cannot be reduced, or the bowel looks dusky, it becomes an emergency operation the same day.
Abdominal operations hold better over time and suit fitter patients; perineal operations are gentler and suit frail patients and emergencies, at the cost of the prolapse returning more often. There is no single best operation — there is a best operation for a particular patient, and it is chosen from fitness, bowel habit and sphincter function.
| Operation | Who it suits | What it does |
|---|---|---|
| Ventral mesh rectopexy | Fitter patients, done through keyhole surgery | The rectum is lifted and held from the front only, leaving the side attachments and their nerves undisturbed — which is why it causes less new constipation than the older posterior operation. It corrects a rectocele at the same time. Uses mesh: see the section below, which is not a footnote. |
| Posterior sutured rectopexy | Fitter patients who do not want mesh, or where mesh is not appropriate | The rectum is fixed to the sacrum with stitches alone. No mesh means none of the mesh-related problems. The side attachments are deliberately preserved, because dividing them is what causes new constipation after this operation. |
| Resection rectopexy | Patients with a long redundant sigmoid and severe constipation alongside the prolapse | The redundant sigmoid is removed and the rectum fixed in the same operation. The procedure of choice when constipation is a major part of the problem. It adds a join in the bowel, and therefore the risks that come with a join. |
| Altemeier perineal rectosigmoidectomy | Frail or high-risk patients, and the strangulated emergency | The prolapsed segment is removed entirely from below, with no cut on the abdomen, sometimes with a pelvic floor muscle repair at the same time. The operation for a prolapse that has become stuck and non-viable. |
| Delorme procedure | Frail patients with a short prolapse | The lining is stripped and the muscle folded on itself, from below. The least invasive of all of these, and the one from which the prolapse returns most often. |
Two principles govern all of them. The side attachments of the rectum and the nerves running in them are preserved wherever possible, because dividing them trades a prolapse for constipation and sexual dysfunction. And the colonoscopy is completed before the elective list, not after.
Mesh used in pelvic floor surgery has been the subject of sustained safety review and, in several countries, of restriction, pause or registry requirements. Mesh rectopexy is therefore not offered here as a routine, uncontroversial operation. It is discussed as a choice, against alternatives that use no mesh at all, and only with consent that names the controversy rather than burying it.
Mesh problems are uncommon, and when they happen they are serious and hard to put right: erosion into the rectum or vagina, long-standing pelvic pain, pain during intercourse, infection, or a fistula. Removing mesh that has caused trouble is difficult, specialised surgery — considerably harder than putting it in, and that asymmetry is the whole reason for caution. What it means in practice here:
Surgery corrects the anatomy. It does not correct a sphincter that has been stretched for years or nerves that have been damaged along the way, which is why control of the bowels improves in many patients, improves partially in others, and does not improve at all in some. Over-promising this is the commonest reason a patient is unhappy after a technically perfect operation.
Three expectations are settled before consent, not after. Continence: if leakage rather than the lump is your main problem, understand that the operation is aimed at the lump. Constipation: it improves for many and worsens for some after a rectopexy, which is why the side attachments are preserved. Recurrence: the prolapse can come back, less often after an abdominal operation than after a perineal one, and a different approach is generally chosen for a second operation. The individualised risks for your age, fitness, sphincter function and previous surgery are set out in writing at the consent discussion, against your own tests rather than an average.
After an abdominal rectopexy most people sit out of bed the same day, eat normally by the second, and go home between the second and fourth day. Laxatives are started early and deliberately, because the one thing that threatens a fresh repair is straining.
Preparation begins before admission: anaemia corrected, sugars controlled, nutrition improved, smoking stopped, and pelvic floor physiotherapy started rather than promised for afterwards. Where a segment of bowel is going to be removed, bowel preparation with oral antibiotics is used, and a stoma site is marked in the small number of patients where a stoma might become necessary during an emergency operation.
Afterwards the plan is written down and is the same for everyone: out of bed on the day of surgery, walking from the first, eating as tolerated, catheter out early unless the pelvic dissection was extensive, and laxatives from day two so the first bowel action involves no straining. Frail patients after a perineal operation move more slowly, with attention on nutrition, skin care and continence rather than speed. You go home once you are eating, walking, comfortable on tablets and afebrile, with your bowels open or a laxative plan in place — carrying a physiotherapy appointment already booked, a written red-flag list, and, if mesh was used, your mesh record.
An operation is the wrong step when the prolapse is internal and has never reached the outside, when conservative treatment has not genuinely been completed, when the dominant problem is leakage from a damaged sphincter rather than the prolapse itself, and when what is actually coming down is mucosal prolapse or piles.
Internal intussusception is the clearest example: found on proctography, it explains obstructed evacuation and responds to physiotherapy, biofeedback and irrigation far more often than to surgery. Solitary rectal ulcer syndrome sits in the same group — biopsied to be certain it is nothing else, then treated by changing how the patient evacuates. And bleeding in someone with a known prolapse is investigated on its own merits, never attributed to the prolapse without looking, which is the same reason the colonoscopy comes first.
From the first consultation to recovery there are five stages, and at each one you are told what happens next and when.
Rectal prolapse surgery is covered by most health insurance policies and by cashless arrangements at Apollo Hospital, Bhat. Insurers ask for evidence of the diagnosis and of what was tried first, so that record is assembled during the work-up rather than in a rush at admission.
What moves the estimate: abdominal or perineal; keyhole or open; whether a segment of bowel is removed, which adds a join and usually a day or two of stay; whether mesh is used and which type; whether another compartment is repaired in the same anaesthetic with gynaecology; the room category; and the length of stay. The office prepares the pre-authorisation with the clinical justification attached and seeks cashless approval before admission wherever the policy allows. Bring the policy document, your ID, previous records, imaging on disc as well as film, and your current prescriptions.
It may improve it, and for many patients it does — but it is not guaranteed and it cannot be predicted. The operation fixes the prolapse; it does not repair a sphincter that has been stretched for years or nerves that have been damaged along the way. If leakage rather than the lump is your main problem, say so at the first consultation, because that changes what is tested and what is offered.
No. Sutured rectopexy, resection rectopexy and the perineal operations all avoid mesh entirely, and they are discussed with you in every case. Mesh in pelvic floor surgery has been the subject of safety reviews and of restriction in several countries, so it is offered as a considered choice with its own consent — never as the default.
Because a growth in the bowel can act as a lead point and drag the rectum down, and because coexisting disease in the colon changes the operation. Every adult has the colon cleared before a planned prolapse operation. It is a short test and it is not negotiable.
Treat it as urgent and ring the office rather than waiting for an appointment. Most can still be reduced with pain relief and steady gentle pressure, and sprinkling ordinary granulated sugar on the swollen lining often shrinks it enough to let that happen. If it cannot be reduced, or the bowel looks dusky, it needs an operation the same day.
For many people it does, and for some it becomes worse — which is why the operation is chosen with the bowel habit in mind. Where there is a long redundant sigmoid and severe constipation, removing that segment at the same time as fixing the prolapse usually serves better than a plain rectopexy. The side attachments of the rectum are preserved wherever possible for the same reason.
Yes. It comes back less often after an abdominal operation and more often after a perineal one, which is part of why a fitter patient is usually offered an abdominal repair. If it does recur, you are re-imaged and reassessed, and a different approach is generally chosen for the second operation rather than repeating the first.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Gota, Ahmedabad, Gujarat
Google rating 4.89 from 216 reviews
Dr Harsh Shah consults at two addresses in the Ahmedabad–Gandhinagar area: the clinic at Gota, Ahmedabad, and Apollo Hospital at Bhat, Gandhinagar.
Patients travel to Dr Harsh Shah with long-standing prolapse and pelvic floor problems from across Gujarat — Gandhinagar, Rajkot, Surat, Vadodara, Bhavnagar, Jamnagar, Junagadh and Kutch — and from Rajasthan and Madhya Pradesh, many having managed it for years before asking. Send the reports on WhatsApp first, so the consultation is spent on the decision.
This operation is one part of what a colorectal surgeon does. For the other colon and rectal conditions that are treated, how the first visit works and which reports to bring, read colorectal surgeon in Ahmedabad: what is treated and when to see one.
Bring any colonoscopy report, any proctography or MR defaecography, and a note of how long the prolapse has been coming down. Those three things decide which operation is even on the table. Call +91-63555-64601 · WhatsApp Dr Harsh Shah's office
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