Pelvic Floor Procedures

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A rectal prolapse is when part of your rectum (back passage) slides out through your anus (the opening in your bottom), forming a swelling there. You may only get the rectal prolapse swelling when you’re passing stools at first, but eventually it might be there all the time.

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Rectal Prolapse


Having a rectal prolapse can be very uncomfortable and interfere with your daily life. It is an embarrassing feeling, but its important to see a specialist to get the right treatment and guidance.

If you have a rectal prolapse, the most obvious symptom is having a lump or swelling coming out of your bottom. Other symptoms of a rectal prolapse may include:

  • being unable to control your bowel movements (when you pass stools), due to stretching of the muscles around your anus – you might not be able to hold it in until you reach the toilet
  • constipation – feeling like you’re unable to pass stools
  • having bright red blood or slimy mucus coming from your rectum
  • feeling some discomfort or pain

Should I push a rectal prolapse myself?

If you or your child has a rectal prolapse, it may go back inside by itself at first after you’ve finished emptying your bowels. But sometimes it doesn’t, and your specialist may show you how to push it back in yourself. Always follow their advice.

Pushing a rectal prolapse back in needs to be done very gently, and you need to try and relax (or encourage your child to relax) while you’re doing it. You’ll probably find it easier to do while lying on your back or side, rather than sitting or squatting down. Press gently and steadily on the prolapsed tissue to help it go back inside through the anus (back passage). Your specialist may advise you to use a little lubricating jelly to help it slide back in more easily.

If the prolapse still won’t go back in, or it becomes painful, or you notice dark or bluish-purple tissue, you should seek medical attention as soon as possible. Don’t keep trying to push it back or you may cause damage to the wall of your bowel.

The best treatment for you will depend on the type of prolapse you have, as well as other things like your age and your overall health. In young children, especially those under the age of four, rectal prolapse usually gets better by itself, without any specific treatment.

Rectal Prolapse
anal stenosis.

Conservative therapy

Before trying other treatment, you might want to:

  • push the prolapse back into place (if your specialist says it’s okay)
  • avoid constipation by adding fibre to your diet and engaging in regular exercise
  • doing pelvic floor exercises
  • not strain when passing stool.

If your symptoms don’t improve, you may need surgery to secure the rectum into place.

For a full-thickness rectal prolapse, adults usually need an operation to fix it.

There are many different ways to surgically correct rectal prolapse.

This may be performed via the abdomen or directly on the prolapse at the anus. The decision to recommend either abdominal or rectal surgery is based on a number of factors including age, physical condition, extent of prolapse, and the results of various tests.  

An abdominal repair (rectopexy) aims to lift the rectum up and fix it so that it cannot prolapse out through the anus again. For many patients, this can be performed laparoscopically (keyhole repair of the prolapsed bowel). The repair is often reinforced with mesh to get the best long-term results. The most modern version of this operations is done Robotically.

Dr. Gheewala has been trained in both Laparoscopic and Robotic Surgery for Rectal Prolapse in the UK. His experience in the field has helped many patients deal with such condition.

Anal Incontinence Treatment

Anal or faecal incontinence can be a very debilitating disease. It is a condition where one loses control over their back passage and it can be of different types. There can be accidental loss of solid stools to liquid stools to accidental loss of flatus (Gas).

There are many causes of faecal incontinence, but most common are with disorders of the anal sphincter (the anal sphincter is a ring of muscle that controls the exit of faeces out of your body) and pelvic floor. Injuries may occur following vaginal delivery, or other anorectal trauma (trauma to back passage). Other causes include radiation to the pelvis, inflammatory bowel disease, behavioural and neurological abnormalities.

Treatment depends on the cause, and hence multiple investigations are carried out.

Management often involves many different approaches.

Some of these are outlined here:

  • Biofeedback with physiotherapy, dietary changes, and medication
  • Surgical correction of rectal prolapse or haemorrhoids, sphincter repair.
  • Sacral Nerve Neuromodulation (SNS)
  • Other options include stoma formation, graciloplasty, sphincter augmentation, artificial sphincters, anal plug
anal stenosis
sphincter repair

Sphincter Repair

This procedure is carried out when the muscle of the anal canal, or sphincter has been torn. This injury most often occurs through vaginal delivery of childbirth. The tear may have been recognised at the time of delivery and repaired, or may not have been obvious, and thus not diagnosed. Also, sphincters can be damaged if surgeries around your back passage gets complicated.

Repair of the sphincter requires a cut through the perineum (region around your bottom), and dissection between the anus and vagina. The ends of the sphincter muscle are dissected then sutured together. It requires experience and training to perform these repairs.

Providing there are no complications, surgery will improve symptoms in 7 to 8 out of 10 people if they have had no major problems with bowel control. It is important to understand that control of gas and liquid stool may not be perfect and that you may still have some urgency, especially if your bowels are loose.

Anal Stenosis


Anal stenosis, which is a narrowing of the anal canal (back passage) that makes it difficult to pass stools, can lead to serious complications if left untreated. Also referred to as anal stricture, this condition occurs when the muscles in the anus—which expand and contract to regulate the passage of faecal material—becomes narrow or tight.

In the majority of cases, anal stenosis is linked to scar tissue formation, which can occur after trauma or any surgery in the anal region (back passage). Other possible causes of anal stenosis include:

  • A congenital malformation
  • Sexually transmitted disease and AIDS
  • Rectal infection
  • Overuse of laxatives

The symptoms of anal stenosis might seem minor at first, but they can worsen with time. They include:

  • Constipation
  • Pain during bowel movements
  • Stools that are narrow and break apart like pellets
  • Bright red blood in the toilet after a bowel movement

The non-surgical treatment options for anal stenosis are limited, though fibre supplements, stool softeners, laxatives may help.

Depending on the severity of the condition, surgery may be an option.

Common surgical options include an anoplasty (correcting the damage in the sphincter muscle), which is the surgical reconstruction of the anus, or a sphincterotomy, which involves the cutting of the internal sphincter muscle to reduce tension. These treatment approaches and many others are offered by Dr. Gheewala.

Pilonidal Sinus

A pilonidal sinus is a small hole or tunnel in the skin at the top of the buttocks, where they divide (the cleft).

Most people with a pilonidal sinus do not notice it unless it becomes infected and causes symptoms.

An infection will cause pain and swelling, and a pus-filled abscess can develop.

In most of the people there are multiple opening as seen in the above pic, there can be infection in these sinuses leading to pus/abscess formation.

It’s very important to keep the area between your buttocks clean by showering or bathing regularly.

Certain factors increase the risk of developing the condition and include:

  • A job involving a lot of sitting (a sedentary occupation, driving).
  • Being overweight or obese.
  • A previous persistent irritation or injury to the affected area.
  • Having a hairy, deep natal cleft.
  • A family history of the condition.
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In most cases, an operation will be advised. There are various operations which are done to cure this problem. Your Specialist Surgeon will be able to give the details and the advantage and disadvantages of each operation.

The options include the following:

  • Wide excision and healing by secondary intention: This operation involves cutting out (excision of) the sinus but also cutting out a wide margin of skin which surrounds the sinus. The wound is not closed but just left open to heal by natural healing processes (healing by ‘secondary intention’). This usually requires several weeks of regular dressing changes until it heals fully. The advantage of this method is that all inflamed tissue is removed and the chance of the condition coming back (a recurrence) is low.
  • Excision and primary closure: This means taking out the section of skin which contains the sinus. This is done by cutting out an oval-shaped (ellipse) flap of skin either side of the sinus, which takes out the sinus. The two sides of the ellipse are then stitched together. The advantage for this is that, if successful, the wound heals quite quickly.
  • A plastic surgery technique: In cases, where the sinus recurs or is extensive, plastic surgery may be advised to remove the sinus and refashion the nearby skin. This takes care of the cleft and removes the entire disease process.