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Bowel dysfunction is an umbrella term to cover a range of disorders or abnormalities that impair the regular function of the bowel. While biofeedback is an adequate treatment in the majority of bowel dysfunction cases, pelvic floor surgery is sometimes required to restore good function. Mr Alexis Schizas, consultant colorectal and general surgeon, explains more about our expertise in treating bowel dysfunction with pelvic floor surgery at St Thomas’ Hospital.
Understanding bowel dysfunction
Bowel dysfunction covers a range of disorders or abnormalities that impair the bowel’s regular function, ranging from issues with bowel movements and control, to digestive problems. Some of the most common types of bowel dysfunction include:
- faecal incontinence
- chronic constipation
- obstructed defecation
- bowel prolapse (including rectal prolapse)
- structural abnormalities
Our specialist consultants at St Thomas’ Hospital are proud of the breadth of our service for patients with bowel dysfunction. We offer a treatment plan tailored to each patient’s needs, from biofeedback and medications to advanced keyhole surgery. Our specialists also offer ongoing support to help patients with their recovery following pelvic floor surgery, and to minimise their chances of future problems with bowel dysfunction.
“One big group of patients we see with bowel dysfunction is those with full thickness rectal prolapse,” says Mr Schizas. “These patients really benefit from minimally invasive pelvic floor surgery, which offers complete prolapse repair in a short procedure with a quick recovery time.”
What is full thickness rectal prolapse?
Full thickness rectal prolapse is a condition where the entire wall of the rectum protrudes through the anus, effectively turning inside out. It’s caused by the weakening of the muscles and ligaments that should support the rectum, meaning that it slips out of its correct position.
There are several causes of full thickness rectal prolapse, but three of the most common causes are chronic straining (from either constipation or diarrhoea), injuries sustained in childbirth, or old age which can weaken the muscles and support structures over time.
Symptoms of full thickness rectal prolapse include:
- discomfort
- bleeding
- mucus discharge
- faecal incontinence
- feeling of incomplete bowel emptying
Full thickness rectal prolapse can affect people of any age or gender, however it is most common in older patients and affects more women than men.
Non-surgical treatment options
Our colorectal specialists carry out a thorough range of initial investigations to establish each patient’s cause of bowel dysfunction, in order to recommend the appropriate treatment. A key element of this is a pressure test – also known as an anorectal manometry – to establish how well the muscles in the back passage work. It may be that the results of this test suggest surgery is required, or it may show that the muscles work as they should. In these cases, biofeedback is the necessary next step.
Biofeedback is a non-invasive therapy used to help patients gain control and improve the coordination and strength of their pelvic floor muscles, anal sphincter and abdominal muscles. “We’re proud to run nurse-led clinics with biofeedback, offering training exercises and information, including advice on toilet positioning, diet and irrigation,” explains Mr Schizas. “We also have a clinical scientist on the team who carries out physiology tests on the anal canal to identify any structural issues.”
For around 90% of patients, conservative biofeedback measures are enough to resolve their symptoms, with aspects including pelvic floor exercises, defecation techniques and hygiene advice all being covered in the nurse-led clinics. Some patients may also be offered medications to assist with slow transit, which can lead to constipation and bloating.
Minimally invasive robotic-assisted bowel surgery
The da Vinci robot, initially developed by Intuitive Surgical, is used in a wide range of surgeries including urological, cardiac and gynaecological. Our specialists in the colorectal team at St Thomas’ Hospital use the da Vinci robot to perform minimally invasive pelvic floor surgery for patients with bowel dysfunction.
The robotic device relies on a camera to provide a high-definition 3D view inside the patient’s body, with the surgeon wearing very small, fully wristed instruments to control the da Vinci system in real time. To repair rectal prolapses, the surgeon accesses the treatment site via the abdomen with enhanced precision, control and flexibility. The rectum is secured into place by attaching it to the sacrum with sutures.
The entire prolapse repair procedure using the da Vinci system can be completed in around 2 hours, with patients usually able to return home the next day. They will continue to see our team of specialists following their prolapse repair surgery, including attending our biofeedback clinics, to minimise the risk of the prolapse recurring and facilitate a smoother recovery. The shorter recovery and reduced scarring associated with the minimally invasive surgery are two of the main benefits.
When to refer
Patients with difficulty defecating, or other associated symptoms, can be referred to our specialist team for investigations to establish the cause of their bowel dysfunction. Biofeedback and non-surgical options will be offered in the first instance, with surgical intervention recommended if other routes are unsuccessful. Our specialists can also offer ongoing support and advice to help patients manage their symptoms independently.
Mr Alexis Schizas
Consultant colorectal and general surgeon
Mr Schizas specialises in the treatment of and surgery for colorectal cancer and pelvic floor imaging. His research interests include pelvic floor imaging, physiology, and treatment for and surgery of colorectal cancer. Mr Schizas has also worked as the laparoscopic and enhanced recovery colorectal lead for the London Cancer Alliance.
Get in touch
For more information on pelvic floor surgery for bowel dysfunction at St Thomas’ Hospital, please contact our customer services team. Call 020 3131 5130 or email privatepatientenquiries@gstt.nhs.uk.