Can altemeier perineal proctectomy with levatorplasty reconstruct the rectum for normal bowel function?

Question

Hello doctor,

I have bowel incontinence issues and severe pain due to receptive anal intercourse and traumatization.

I had rectal mucosa prolapse six years back. Anogenital warts were excised two years back, and hemorrhoidectomy, excision, and fulguration of anal lesions were performed later. I am advised now to have altemeier perineal proctectomy with levatorplasty. After having two surgeries over the past nine months, I am worse off than I was before the first surgery. Can the rectum be reconstructed to allow for normal bowel function and receptive anal sex after having an altemeier perineal proctectomy with levatorplasty procedure?

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I have reviewed your case history and attached report (attachments removed to protect the patient's identity). The procedure you mentioned is definitely for rectal prolapse, and it is necessary considering your history of active prolapse, which was seen during your examination under anesthesia, and this causes on-and-off significant bleeding as well.

So now, returning to your question about normal bowel passage and receptive anal sex. During this procedure, the surgeon predominantly removes the prolapsed part, which will likely include your rectum and some of the sigmoid, depending on the extent of the prolapse. Then, they usually try to preserve the anal sphincter and try to do colo-anal anastomosis. This anastomosis will take time to heal like any other wound. Once it is healed, you should pass stools through the normal passage. Initially, it may be more watery, followed by semi-solids to solids.

Regarding receptive anal sex, once it is healed completely, you may consider it. Still, your surgeon will be the best person to guide you considering your surgery, followed by a recovery phase and later on doing your physical examination and deciding to what extent you can perform receptive anal sex.

I hope this helps.

Thank you and take care.