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.