Rectal Prolapse Sclerotherapy

Rectal prolapse Sclerotherapy

Sclerotherapy is a non-invasive procedure in which a solution (known as a sclerosant) is injected into varicose veins that cause inflammation of the vessel walls leading to scarring and closure of the veins. In relation to rectal prolapse, it is mostly used for mild or early prolapse or prolapse of the mucosa of the rectum. The process operates by making the rectal wall and sub mucosal tissue stiffer and thicker to ensure that the rectum does not stick out of the anus.

Indications

A sclerotherapy of rectal prolapse is recommended in:

• Mucosal prolapse (partial prolapse of rectal mucosa)
• Rectal prolapse at an early stage in elderly patients or high-risk patients in whom surgery is dangerous.
• Patients who require an alternative to surgery that is less invasive.
• It has less potency when it comes to full-thickness prolapse of the rectum or those that recur.

Advantages

• Minimally invasive
• Under local anesthetic, can be done.
• Outpatient procedure
• Appropriate with the patient who cannot be operated.

Rectal prolapse sclerotherapy procedure

This is a procedure to explain the rectal prolapse sclerotherapy step by step:

Preparation of the patient

• Assessment: Judge the degree of prolapse (mucosal, full-thickness) by physical examination or proctoscopy.
• Bowel regimen: A gentler enema or bowel regimen is frequently recommended. 
• Anaesthesia: Local with oderate sedation. General anaesthesia is rarely required.
• Position: The patient should be placed in lithotomy or knee chest position to have best exposure to the rectum.

Material and Equipment

• Anoscope or Proctoscope: To visualize the prolapse.
• Syringe and fine needle (usually 25-27G) 

Sclerosing agent: These include:

• Phenol in oil
• Hypertonic saline
• Sodium tetradecyl sulfate
• Polidocanol
• Sterile gloves, antiseptic solution, drapes.

Procedure Steps

Visualization:

• The prolapsed part can be brought back (where possible) and examined by proctoscope.

Injection:

• The sclerosing agent is introduced in the submucosal part of the prolapsed tissue.
• Injections are circumferential (generally 4 to 6 points round the rectal wall).
• Volume per site is determined very attentively so as to not over-inject and hence necrosis.

Observation:

• Minimal blanching or swelling can occur at the location of the injection.
• Inhibits the effect and proper placement of tissues.

Completion:

• Upon completion of all the injections, the needle is removed.
• A few minutes of observation of patient are to be done on whether he/she has any acute complications.

Post-procedure Care

• Recovery: It is often outpatient; patient may return home the same day.
• Pain management: Light analgesic on demand.
• Bowel care: advised to use stool softeners to prevent straining.
• Activity: Generally, the normal activities can be resumed and those that involve heavy lifting or straining are to be discouraged.
• Follow up: Generally 2-4 weeks to determine fibrosis and recurrence.

Sclerotherapy for rectal prolapse recovery

The following is a breakdown of the recovery following sclerotherapy of rectal prolapse:

Immediate Post-Procedure

• It is usually performed on an outpatient basis, with most patients going home the day of their surgery. 
• Mild pain, discomfort, or burning of the injection point is normal.
• Male bleeding or spotting can take place 1-2 days in small quantities.
• Patients are followed in short to detect any immediate complications (rare).

Pain Management

• Light narcotic medications such as acetaminophen are normally adequate.
• Strong pain drugs should be avoided without a prescription.

Bowel Care

• Stool softeners are given to prevent straining.
• A high-fibre diet with adequate fluids can help keep the stools soft.
• Don’t get constipated or strain too hard in 2 to 4 weeks.

Activity

• The majority of patients are able to continue with the normal routine daily.
• The first 1-2 weeks should not be characterized by heavy lifting or intense exercise.
• Sexual activity could be generally resumed when there is lack of pain or bleeding.

Follow-Up

First follow-up: 2-4 weeks after the procedure to evaluate:

• Healing of injection sites
• Reduction in prolapse
• Complications (infection, ulceration) signs.
• Further sessions can be necessary in case of inadequate fibrosis or partial prolapse.

Expected Healing

• Fibrosis slowly develops in the injected tissue and anchors the rectum in 2-4 weeks.
• Some slight discomfort or fullness could continue at this stage.
• Prolapse symptoms can require weeks of time to be fully resolved.

Rectal prolapse sclerotherapy complications

The following are the complications of sclerotherapy of rectal prolapse in detail:

Common, Mild Complications

• Pain or discomfort
• Minor bleeding or spotting
• Swelling or fullness sensation

Moderate Complications

• Ulceration at injection site
• Infection
• Tissue inflammation

Rare, Serious Complications

• Tissue necrosis
• Severe bleeding
• Recurrence of prolapse

Best hospital for rectal prolapse sclerotherapy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Sclerotherapy is an outpatient procedure that is minimally invasive and mainly used in cases of mucosal prolapse or early-stage rectal prolapse, specifically those patients that are high-risk surgery. It causes fibrosis and tissue tightening by injecting a sclerosing agent into the submucosal tissue to aid in preventing the recurrence of prolapse. In general, rectal prolapse sclerotherapy is a safe and effective method of treating patients with a particular condition in place of surgery, although patients have to be carefully selected and followed to achieve the best results.

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FAQ

Does sclerotherapy work with any form of prolapse?

• Most useful in cases of mucosal prolapse or prolapse of small degree
• Weak in full-thickness or recurrent prolapse; operation may be a good choice in such instances.

How many sessions are needed?

• Typically a single session though more sessions can be needed when the prolapse is chronic or recurrent.

What is the best way to avoid repetition?

• Do not strain when you have to move the bowels.
• Have soft stools by taking fiber and fluids.
• Follow up with proctologist on a regular basis.

Is a surgery-sclerotherapy substitution possible?

• It is possible to be an alternative option of selected patients.
• Surgery is still considered the gold standard to use in full-thickness or recurrent prolapse because it has lower recurrence.