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Rectal prolapse in elderly

Published 13 March 2026 ·Last reviewed 13 March 2026 by the editorial team ·How we create our content

At a glance

Rectal prolapse is particularly common in older adults, especially women over 70. Management in this age group requires balancing treatment effectiveness with the specific considerations of age — co-existing health conditions, anaesthetic risk, and the practical realities of recovery.

This guide covers the range of management options available to older adults with rectal prolapse.

The specific challenges in older adults

Multiple health conditions

Many older adults with rectal prolapse also have other health conditions — heart disease, lung disease, diabetes, mobility limitations — that affect treatment decisions. These co-morbidities influence:

  • Whether general anaesthesia is safe
  • How well the person can tolerate and recover from surgery
  • Which surgical approach is most appropriate
  • Whether conservative management is the safer choice

Frailty and recovery

Recovery from surgery requires a period of reduced activity, adequate nutrition, and wound healing capacity. For frail older adults, the recovery period itself carries risks — deconditioning, infection, confusion — that need to be weighed against the benefits of treating the prolapse.

Continence

Faecal incontinence often coexists with rectal prolapse in older adults. The prolapse stretches the anal sphincter, and age-related weakening of the pelvic floor compounds the problem. Addressing the prolapse can improve continence, but the degree of improvement depends on how much the sphincter has been compromised.

Conservative management

For older adults who are not surgical candidates, or who prefer not to have surgery:

Manual reduction

Learning to gently push the prolapse back in (reduce it) is a practical skill:

  • Using gentle pressure with toilet paper or a gloved finger
  • Applying the pressure gradually — not forcing
  • This becomes a routine part of managing the condition
  • Carers may need to be taught this technique

Stool management

Reducing straining is particularly important:

  • Ensuring soft, well-formed stools through fibre and hydration
  • Using stool softeners if needed
  • Good toilet posture — a footstool to raise the knees
  • Not sitting on the toilet for prolonged periods

Pelvic floor support

Where mobility allows:

  • Gentle pelvic floor exercises — even modified versions can help
  • Pelvic floor physiotherapy if accessible
  • Focus on function rather than intensive exercise

Continence management

When incontinence accompanies the prolapse:

  • Continence pads for practical management
  • Skin care to prevent moisture damage
  • Discussion with a continence specialist about available support

Surgical options for older adults

Perineal procedures (preferred for high-risk patients)

These avoid abdominal surgery entirely:

Delorme’s procedure: removes the mucosal lining and plicates (folds) the muscle wall. Can be done under spinal or regional anaesthesia. Shorter procedure, quicker recovery.

Altemeier’s procedure: removes the prolapsed segment through the perineum. Suitable for larger prolapses. Also possible under regional anaesthesia.

Advantages for older adults:

  • Avoidable general anaesthesia in many cases
  • Shorter operating time
  • Faster recovery
  • Less physiological stress

Trade-off: higher recurrence rates than abdominal procedures.

Abdominal procedures (for fitter patients)

For older adults who are assessed as fit enough:

  • Laparoscopic rectopexy offers lower recurrence rates
  • The decision to proceed depends on the individual’s overall fitness, not age alone
  • A thorough anaesthetic and medical assessment guides this decision

The decision-making process

The choice is not simply about age. It involves:

  • A comprehensive assessment of fitness for surgery and anaesthesia
  • Discussion of the goals of treatment — symptom relief, continence improvement, quality of life
  • Honest conversation about the risks and benefits of each approach
  • Involvement of the patient and family in the decision
  • Sometimes the best decision is conservative management, and that is a valid choice

Quality of life focus

For older adults, the treatment goal is often comfort and dignity rather than anatomical perfection:

  • Reducing the frequency and severity of prolapse episodes
  • Improving or maintaining continence
  • Enabling participation in daily activities
  • Minimising the burden of management — for both the patient and carers
  • Honest discussions about realistic outcomes

Rectal prolapse in an older adult is not something that has to be accepted as “just part of ageing.” Treatment options exist across the spectrum of fitness levels, and a conversation with a specialist can clarify what is appropriate for each individual.

Common questions

Is rectal prolapse surgery safe for elderly patients?

Many older adults undergo rectal prolapse surgery safely. The choice of procedure is tailored to the individual — perineal approaches (Delorme's, Altemeier's) can be performed under regional anaesthesia, which may be preferable for those who cannot tolerate general anaesthesia. A thorough pre-operative assessment helps determine the safest approach.

What if an elderly person is not fit for surgery?

Conservative management is an option for those who are not surgical candidates. This includes managing constipation, learning to reduce the prolapse manually, pelvic floor exercises where possible, and using supportive devices. The goal shifts to comfort and maintaining quality of life.

Does rectal prolapse affect continence in the elderly?

Rectal prolapse frequently contributes to faecal incontinence, particularly in older adults. The prolapse stretches the sphincter muscles over time. Treating the prolapse can improve continence, though if the sphincter has been weakened over a long period, some incontinence may persist.

When to seek care Heavy bleeding or feeling faint? Get emergency help now. Emergency: 911

Not sure how urgent it is? Get help today.

  1. Emergency

    Heavy bleeding, black tarry stools, feeling faint, severe pain or trouble breathing.

    Call 911 or go to the ER.

  2. Today

    Fever, pain getting worse, a hot swollen lump, or trouble passing urine.

    Call your doctor or go to urgent care.

  3. Soon

    Bleeding or bowel changes nobody has checked, or anything lasting 3 weeks.

    Book a doctor’s appointment.

Feeling overwhelmed? Call or text 988, any time.

See all the signs

For this topic, get medical advice if you notice:

  • Prolapse that cannot be pushed back in (incarcerated)
  • Tissue that looks dark, blue, or discoloured
  • Severe pain with prolapse
  • Significant rectal bleeding
  • Signs of bowel obstruction — vomiting, severe bloating, inability to pass wind

Recording how you feel is not the same as being checked. These are the signs that need a doctor’s attention.

Call 911 or go to the emergency room now if you have:

  • bleeding that will not stop, a lot of blood (the toilet water turns red, or you pass large clots), or any bleeding with feeling faint or dizzy
  • fainting, a racing heart or trouble breathing
  • confusion or slurred speech, extreme shivering, no urine in a day, or blotchy skin
  • sudden severe belly pain, or a swollen, hard belly with vomiting or not passing stool or gas
  • you cannot pass urine at all, or your bladder feels full and painful and you can’t empty it
  • redness, swelling or severe pain spreading quickly around your anus, genitals or groin, especially with a fever or feeling very ill
  • a fever with a painful swelling near your anus if you have diabetes or a weakened immune system (for example, from chemotherapy or transplant medicines)
  • black, tarry stools

Call your doctor or go to urgent care today (or the ER if you can’t be seen today) if you have:

  • a temperature of 100.4°F (38°C) or higher, chills, vomiting, or feeling generally unwell
  • pain that is getting worse over days, or severe pain that stops you sitting or sleeping
  • a hot, swollen or very tender lump near your anus or at the top of the crease between your buttocks, or foul-smelling discharge
  • trouble urinating
  • bleeding that is getting heavier or more frequent, or blood mixed into your stool
  • feeling much more tired than usual, looking pale, or getting out of breath more easily than you used to
  • not passing stool for several days, or new belly pain

Make an appointment with your doctor if:

  • you have never had these symptoms checked by a doctor or nurse — whatever your age
  • you have had rectal bleeding for more than 3 weeks
  • your bowel movements have been looser, thinner or more frequent than usual for 3 weeks or more, or you have lost weight without trying
  • symptoms have not settled after a week or so, or keep coming back
  • you notice a new lump near your anus, between your buttocks or in your belly, or an itch or discharge that does not clear
  • you have new leakage or trouble controlling your bowels
  • you are 45 or over, or have a family history of bowel cancer or inflammatory bowel disease, and any of these symptoms are new for you

If you are unsure, it is always reasonable to ask. If things feel overwhelming, call or text 988 (Suicide & Crisis Lifeline) or chat at 988lifeline.org, any time. If you don’t feel safe, call 911.

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