At a glance
When conservative measures are not managing rectal prolapse adequately, surgery is often the next conversation. There are several surgical approaches, and the right choice depends on factors including the type and severity of the prolapse, your age, overall health, and your surgeon’s experience.
This guide provides an overview of the main surgical options, what each involves, and what people commonly describe about recovery. It is not a recommendation for any specific procedure — that decision belongs to you and your surgical team.
Understanding the two main approaches
Rectal prolapse surgery falls into two broad categories:
Abdominal procedures
The surgeon accesses the rectum through the abdomen. These procedures aim to secure the rectum in its correct position.
- Generally lower recurrence rates compared to perineal approaches
- Longer recovery — particularly with open surgery
- Typically require general anaesthetic
- May be performed laparoscopically (keyhole) or robotically in many centres
Perineal procedures
The surgeon works through the anus and perineum, without entering the abdomen.
- Shorter procedures with typically shorter recovery times
- Can often be done under regional anaesthesia — important for older adults or those with significant other health conditions
- Generally higher recurrence rates than abdominal approaches
- Less post-operative pain in many cases
Common abdominal procedures
Rectopexy (mesh or suture)
The most widely performed abdominal approach. The surgeon mobilises the rectum and fixes it to the sacrum (the bone at the base of the spine), sometimes using mesh and sometimes using sutures alone.
- Laparoscopic rectopexy is increasingly the standard approach — smaller incisions, shorter hospital stay
- Ventral mesh rectopexy secures mesh to the front of the rectum and attaches it to the sacrum, supporting the rectum without fully mobilising it from behind
- Suture rectopexy uses stitches rather than mesh — avoids mesh-related complications but may have slightly different recurrence patterns
People describe recovery from laparoscopic rectopexy as typically involving a few days in hospital, gradual return to normal activities over three to six weeks, and restrictions on heavy lifting for several weeks.
Resection rectopexy
Combines rectopexy with removal of a section of the sigmoid colon. This may be considered when there is significant redundant bowel (a long, loopy sigmoid colon) contributing to the problem.
- Addresses both the prolapse and associated constipation in some cases
- More extensive procedure with a longer recovery
- Carries the additional risks of bowel surgery — anastomotic leak, infection
Common perineal procedures
Delorme’s procedure
The surgeon removes the inner lining (mucosa) of the prolapsed rectum and then folds and stitches the muscular wall to shorten and tighten the rectum.
- Can be performed under spinal or regional anaesthesia
- Shorter procedure — typically 30 to 60 minutes
- Recovery is usually faster than abdominal approaches
- Recurrence rates are higher — this is the main trade-off
- Often chosen for older adults or those with significant co-morbidities
Altemeier’s procedure (perineal rectosigmoidectomy)
The surgeon removes the prolapsed section of rectum and sigmoid colon through the perineum, then reconnects the bowel.
- More extensive than Delorme’s but still avoids abdominal surgery
- Suitable for larger prolapses where Delorme’s may not be sufficient
- Can be performed under regional anaesthesia
- Recovery is typically two to four weeks of restricted activity
How the decision is made
Your surgeon will consider several factors:
- Type and extent of prolapse — full-thickness vs mucosal; how much tissue is involved
- Your overall health and fitness for surgery — particularly your ability to tolerate general anaesthesia
- Your age — while age alone does not determine the approach, it influences risk-benefit discussions
- Associated symptoms — constipation, incontinence, or both
- Previous abdominal surgery — may affect the feasibility of abdominal approaches
- Surgeon experience — outcomes are influenced by surgical volume and expertise
Questions people commonly ask their surgeon
- Which procedure do you recommend for my situation, and why?
- What is the recurrence rate for this specific procedure in your experience?
- Will this be done laparoscopically or open?
- What type of anaesthesia will be used?
- How long will I be in hospital?
- What are the main risks specific to this procedure?
- What should I expect for recovery — when can I return to work, driving, and normal activities?
- Will this help with my continence issues?
- What happens if the prolapse comes back?
Recovery patterns people describe
Recovery experiences vary considerably, but common themes include:
- Pain is generally manageable — most people describe post-operative discomfort rather than severe pain
- Bowel function takes time to settle — irregular movements, urgency, or difficulty in the first few weeks are commonly reported
- Lifting restrictions are typically in place for four to eight weeks depending on the procedure
- Gradual improvement — most people describe feeling significantly better by six to eight weeks, with continued improvement over several months
- Pelvic floor physiotherapy is often recommended as part of recovery
What this guide cannot tell you
Every prolapse is different, and the best surgical option depends on your individual anatomy, health, and circumstances. This guide provides a framework for understanding the options, but the specific recommendation should come from a surgeon who has examined you and understands your situation.
If you are preparing for a surgical consultation, having an understanding of these options can help you ask informed questions and participate more actively in the decision.