When Is Surgery Needed for Rectal Prolapse?

For most adults with symptomatic full-thickness rectal prolapse, surgery is the definitive treatment. Fiber, stool softening, constipation treatment, and pelvic floor care may reduce straining or improve associated symptoms, but they do not restore the rectum to its normal position or permanently correct full-thickness prolapse.

Surgery should be discussed when prolapse repeatedly extends through the anus, requires manual reduction, causes bleeding or mucus drainage, worsens constipation or fecal incontinence, or interferes with daily activities. The timing and type of operation depend on the prolapse anatomy, bowel function, overall health, previous operations, and treatment goals.

Not every condition called “prolapse” is the same. Internal rectal intussusception, mucosal prolapse, prolapsing hemorrhoids, and full-thickness external rectal prolapse may require different treatment. A colorectal examination is therefore essential before deciding whether surgery is appropriate.

Quick Answer: What Signs Suggest Surgery May Be Needed?

Surgery is commonly considered when one or more of the following are present:

• Full-thickness rectal tissue repeatedly protrudes through the anus
• The prolapse no longer returns inside on its own
• The tissue must be manually pushed back into place
• Episodes are becoming more frequent or lasting longer
• Bleeding, mucus drainage, irritation, or skin problems persist
• Constipation, obstructed defecation, or incomplete emptying is worsening
• Stool leakage or loss of bowel control affects daily life
• The prolapse interferes with walking, exercise, work, travel, hygiene, or social activity
• Symptoms continue despite treatment of constipation, diarrhea, or straining
• Complications develop, such as incarceration or impaired blood supply

The decision is based on the overall pattern—not on a single symptom.

Which Type of Rectal Prolapse Usually Requires Surgery?

Full-thickness external rectal prolapse

Full-thickness prolapse occurs when the entire rectal wall telescopes downward and extends through the anus. It typically produces circular or concentric folds of tissue.

In adults, symptomatic full-thickness rectal prolapse is usually treated surgically because nonoperative care does not correct the underlying anatomic problem.

Mucosal prolapse

Mucosal prolapse involves only the inner lining of the rectum rather than the full rectal wall. Treatment depends on the extent of prolapse, symptoms, and whether another condition—such as hemorrhoids—is present.

Internal rectal intussusception

Internal prolapse occurs when the rectum folds inward but does not extend outside the anus. Some patients have no symptoms, while others experience obstructed defecation, incomplete emptying, pelvic pressure, or pain.

Surgery is not automatically required for every internal prolapse. Evaluation may include bowel-regulation therapy, pelvic floor assessment, defecography, and consideration of other causes of symptoms before an operation is recommended.

Learn more about the types and symptoms of rectal prolapse.

Can Rectal Prolapse Be Treated Without Surgery?

Nonoperative treatment can improve symptoms and reduce straining, but it does not permanently correct full-thickness rectal prolapse in adults.

Supportive treatment may include:

• Increasing dietary fiber gradually
• Drinking adequate fluids
• Using a stool softener or osmotic laxative when recommended
• Treating chronic constipation
• Managing persistent diarrhea
• Avoiding repeated straining
• Limiting prolonged toilet sitting
• Protecting irritated perianal skin
• Pelvic floor physical therapy in selected patients
• Treating associated pelvic floor dysfunction

These measures remain useful before and after surgery because improved bowel habits may reduce symptoms and lower stress on a repair.

Read more about rectal prolapse treatment without surgery.

When Is Conservative Treatment No Longer Enough?

Supportive care is less likely to be sufficient when the prolapse itself is persistent or progressively symptomatic.

Increasing frequency or size

Prolapse that occurs with most bowel movements, appears with standing or walking, or extends farther than before suggests progression.

Need for manual reduction

When tissue must routinely be pushed back inside, the prolapse is no longer reducing normally.

Persistent bleeding or mucus drainage

Repeated exposure and friction can cause irritation, ulceration, mucus discharge, or bleeding. Persistent bleeding should also be evaluated to exclude another colorectal source.

Worsening bowel dysfunction

Rectal prolapse may be associated with:

• Difficulty initiating a bowel movement
• Incomplete emptying
• Repeated straining
• A sensation of blockage
• Constipation
• Fecal urgency
• Stool leakage or fecal incontinence

Reduced quality of life

Surgery may be reasonable even when the condition is not emergent if prolapse limits hygiene, mobility, work, exercise, sexual activity, travel, or social participation.

Should Surgery Be Delayed Until Rectal Prolapse Becomes Severe?

Not necessarily.

The American Society of Colon and Rectal Surgeons advises that reasonable surgical candidates should avoid unnecessary delay because untreated rectal prolapse may contribute to worsening bowel-control function and may become more difficult to manage over time.

A planned evaluation does not mean that every patient must have immediate surgery. It allows the surgeon and patient to:

• Confirm the diagnosis
• Determine the prolapse type
• Evaluate constipation and continence
• Identify associated pelvic organ prolapse
• Review operative risks and expected benefits
• Choose the most appropriate timing and procedure

Age alone does not determine whether surgery is appropriate. Overall health, frailty, functional status, symptoms, anesthetic risk, and patient goals are more important.

When Is Rectal Prolapse Surgery Urgent?

Most rectal prolapse surgery is scheduled electively. However, urgent medical evaluation is required when:

• The prolapse cannot be pushed back inside
• The tissue becomes dark red, purple, dusky, gray, or black
• Severe or rapidly worsening pain develops
• Swelling increases and prevents reduction
• Heavy bleeding occurs
• Fever, fainting, marked weakness, or systemic illness develops

A prolapse that cannot be reduced may become incarcerated and lose its blood supply. NIDDK identifies an irreducible prolapse as a medical emergency because strangulation can damage the exposed rectal tissue.

Learn more about when rectal prolapse is an emergency.

How Does a Colorectal Surgeon Confirm That Surgery Is Appropriate?

The initial evaluation usually includes a detailed history and physical examination focused on the prolapse, sphincter function, constipation, fecal incontinence, and related pelvic floor symptoms.

The surgeon may ask about:

• When the prolapse occurs
• Whether it reduces spontaneously
• Whether manual reduction is required
• Bleeding or mucus drainage
• Constipation, diarrhea, or straining
• Stool leakage or urgency
• Previous pelvic or abdominal surgery
• Prior colorectal procedures
• Urinary or vaginal prolapse symptoms
• Current medications and medical conditions
• Previous colonoscopy results

If the prolapse is not visible during the office examination, the patient may be asked to strain in a seated or squatting position. A photograph taken during a typical episode may also help distinguish full-thickness prolapse from hemorrhoids or mucosal prolapse.

What Tests May Be Needed Before Surgery?

Not every patient needs every test. Testing is selected according to symptoms, examination findings, age, screening history, and the planned procedure.

Defecography

Fluoroscopic or MRI defecography shows how the rectum and pelvic floor move during evacuation. It may identify internal intussusception, rectocele, enterocele, or other pelvic floor abnormalities.

Colonoscopy

Colonoscopy may be performed before surgery to evaluate the colon, investigate bleeding, complete colorectal cancer screening, or exclude a lesion that could alter the operative plan.

Anorectal manometry

Manometry measures anal sphincter pressures and coordination. It may be useful when fecal incontinence, obstructed defecation, or pelvic floor dysfunction is prominent.

Colonic transit or additional functional testing

Patients with severe or longstanding constipation may require additional evaluation because preoperative bowel function can influence the choice of operation.

What Operations Are Used for Rectal Prolapse?

Rectal prolapse operations are generally performed through an abdominal approach or a perineal approach. The appropriate operation is individualized.

Abdominal rectopexy

An abdominal operation restores the rectum to its normal position and secures it within the pelvis. It may be performed through minimally invasive laparoscopic or robotic techniques when appropriate.

Examples include:

• Suture rectopexy
• Resection rectopexy in selected patients
• Ventral rectopexy

Perineal repair

A perineal operation is performed through the anus and perineum without abdominal incisions.

Examples include:

• Delorme procedure
• Perineal rectosigmoidectomy, also called the Altemeier procedure

The selection of abdominal versus perineal surgery depends on factors including:

• Overall health and anesthetic risk
• Prolapse length and anatomy
• Previous abdominal or pelvic operations
• Constipation
• Fecal incontinence
• Pelvic floor findings
• Surgeon expertise
• Patient preferences and treatment goals

No single procedure is best for every patient. The ASCRS guideline emphasizes tailoring the operation to the patient’s medical condition, bowel function, surgical history, and individual priorities.

Review the diagnostic and surgical procedures used for rectal prolapse.

How Do Constipation and Fecal Incontinence Affect the Surgical Plan?

Bowel function is an important part of procedure selection.

Constipation

Some operations may improve constipation, while others can produce or worsen it. Patients with severe constipation, slow colonic transit, or pelvic floor dyssynergia may need additional testing before surgery.

The surgeon may modify the operative approach based on whether constipation is caused by:

• Obstructed defecation
• A redundant sigmoid colon
• Pelvic floor dyssynergia
• Slow-transit constipation
• The prolapse itself

Fecal incontinence

Rectal prolapse can hold the anal sphincter open and chronically stretch the sphincter muscles and nerves. Many patients experience some improvement in continence after the prolapse is repaired, although recovery varies and persistent incontinence may require additional treatment.

Surgical correction of the prolapse is commonly addressed before deciding whether a separate continence procedure is needed.

Does Rectal Prolapse Surgery Always Cure the Problem?

Surgery usually corrects the prolapse, but no operation guarantees permanent cure. Recurrence can occur after any repair.

Outcomes depend on:

• Prolapse type and duration
• Pelvic floor strength
• Constipation and straining
• Previous prolapse surgery
• Overall tissue quality
• Procedure selected
• Postoperative bowel habits
• Other pelvic floor disorders

The goals of surgery are to:

1. Correct the prolapse
2. Improve constipation or fecal incontinence when possible
3. Avoid creating new bowel dysfunction
4. Improve comfort, hygiene, function, and quality of life

A careful preoperative discussion should include expected benefits, recurrence risk, bowel-function outcomes, recovery, and procedure-specific risks.

What Kind of Doctor Performs Rectal Prolapse Surgery?

Rectal prolapse is typically evaluated and treated by a colon and rectal surgeon, also called a colorectal surgeon.

A colorectal surgeon has specialized training in disorders of the colon, rectum, anus, and pelvic floor and can:

• Distinguish rectal prolapse from hemorrhoids and mucosal prolapse
• Evaluate associated constipation or fecal incontinence
• Determine whether surgery is appropriate
• Select an abdominal or perineal approach
• Coordinate care with urogynecology or pelvic floor specialists when needed
• Manage postoperative bowel-function concerns

See the difference between rectal prolapse and hemorrhoids.

Rectal Prolapse Surgery Evaluation in Phoenix

Rectal prolapse should be evaluated when tissue repeatedly protrudes through the anus, requires manual reduction, causes bleeding or mucus drainage, or affects bowel control and daily activities.

Dr. Aisha Akhtar, MD is a board-certified colon and rectal surgeon who evaluates rectal prolapse, constipation, fecal incontinence, hemorrhoids, rectal bleeding, and other colorectal conditions for patients in Phoenix, Scottsdale, Glendale, and surrounding Arizona communities.

Schedule an Appointment

Frequently Asked Questions

Does every adult with rectal prolapse need surgery?

Not every internal or mucosal prolapse requires surgery. However, symptomatic full-thickness external rectal prolapse in adults is generally treated surgically because nonoperative measures do not correct the underlying anatomic prolapse.

Can pelvic floor exercises cure full-thickness rectal prolapse?

Pelvic floor therapy may improve coordination, straining, or associated pelvic floor symptoms in selected patients, but it does not permanently restore a full-thickness external prolapse to its normal position.

How do I know whether my prolapse is full thickness?

Full-thickness prolapse typically has circular or concentric folds. Prolapsing hemorrhoids or mucosal prolapse more often show radial folds. A colorectal examination is required to confirm the diagnosis.

Is surgery necessary if the prolapse can still be pushed back in?

A reducible prolapse is not necessarily an emergency, but recurrent prolapse that requires manual reduction is a reason to discuss elective repair. Waiting until it becomes irreducible may increase the risk of complications.

Can surgery improve fecal incontinence?

Many patients have improved bowel control after repair because the prolapse no longer holds the sphincter open. Improvement is not guaranteed, particularly when there is longstanding nerve or sphincter damage.

Can rectal prolapse surgery worsen constipation?

Some operations may worsen constipation, while others may be selected specifically for patients with constipation. This is why bowel function and, when appropriate, physiologic testing are reviewed before choosing a procedure.

Is rectal prolapse surgery always performed through the abdomen?

No. Surgery may be performed through the abdomen or through the perineum. The approach depends on health status, prolapse anatomy, bowel function, prior operations, surgeon experience, and patient preferences.

When should I go to the emergency department?

Seek urgent care if the prolapse cannot be reduced, becomes dark or dusky, causes severe pain, or is associated with heavy bleeding, fainting, fever, or rapidly increasing swelling.

Learn More About Rectal prolapse

You may also explore these guides:

• Rectal prolapse Overview
• Rectal prolapse Symptoms
• Rectal prolapse Procedures
• Rectal prolapse FAQ
• Rectal prolapse Images & Diagrams