For adults with symptomatic full-thickness rectal prolapse, surgery is generally the definitive treatment. Fiber, stool regulation, constipation treatment, and pelvic-floor care may improve associated symptoms, but they do not permanently correct an established full-thickness prolapse.
The operation is individualized. A colon and rectal surgeon considers the prolapse anatomy, constipation, fecal incontinence, pelvic-floor function, previous abdominal or pelvic surgery, overall health, operative risk, and the patient’s goals before recommending an abdominal or perineal repair.
Schedule a Rectal Prolapse Evaluation with Dr. Aisha Akhtar, MD, a board-certified colon and rectal surgeon in Phoenix, Arizona, or call 602-932-5660.
| Treatment approach | What it can do | What it cannot do |
|---|---|---|
| Bowel regulation and constipation management | Reduce straining, irritation, and difficult bowel movements | Permanently repair full-thickness prolapse |
| Pelvic-floor therapy in selected patients | Address associated pelvic-floor dysfunction or evacuation problems | Reliably reverse established external full-thickness prolapse |
| Abdominal rectopexy | Return the rectum to its normal position and secure it in the pelvis | Guarantee that prolapse or bowel symptoms will never recur |
| Perineal repair | Remove or repair prolapsed tissue through the anus and perineum | Provide the same risk-benefit balance for every patient |
There is no single operation that is best for everyone.
Nonsurgical care may improve bowel function, reduce irritation, and make symptoms easier to manage while a patient is being evaluated or when surgery must be delayed.
Management may include:
These measures can be valuable, but they should not be presented as a cure for full-thickness external rectal prolapse.
Read whether rectal prolapse can be treated without surgery.
Surgical repair is commonly discussed when prolapse:
A reducible prolapse is not necessarily an emergency, but recurrent full-thickness prolapse generally deserves colorectal surgical evaluation rather than indefinite observation.
See when surgery may be needed for rectal prolapse.
Most operations use one of two routes.
| Approach | How it is performed | Examples | Factors in selection |
|---|---|---|---|
| Abdominal repair | The rectum is repositioned and secured from within the abdomen | Suture rectopexy, ventral rectopexy, resection rectopexy in selected patients | Prolapse anatomy, constipation, previous surgery, overall health, and surgeon judgment |
| Perineal repair | The prolapsed rectum is treated through the anus and perineum | Perineal rectosigmoidectomy, Delorme procedure | Prolapse length, health, operative risk, anatomy, and patient goals |
Both routes have potential advantages, limitations, complications, and recurrence risks. Procedure selection should be based on the individual patient rather than age or procedure name alone.
Rectopexy is an abdominal operation in which the rectum is returned to its normal position and secured within the pelvis. Depending on the situation, it may be performed laparoscopically, robotically, or through an open operation.
The rectum is mobilized and secured within the pelvis using sutures.
An anterior approach is used to support and elevate the rectum. Reinforcing material may be used depending on the procedure and patient-specific factors.
In selected patients, particularly when significant constipation and a redundant sigmoid colon affect planning, a portion of the sigmoid colon may be removed together with rectal fixation.
Perineal rectosigmoidectomy, also called the Altemeier procedure, removes the prolapsed segment through the perineum. It may be considered according to the patient’s health, anesthetic risk, prolapse anatomy, previous surgery, and treatment goals.
The Delorme procedure removes the prolapsed mucosal lining and folds the underlying muscle. It may be considered in selected patients with a shorter segment of full-thickness prolapse.
For a concise description of tests and operations, visit rectal prolapse tests and procedures.
The treatment decision may account for:
The procedure that best addresses prolapse may differ for a patient whose main concern is severe constipation versus one whose main concern is fecal incontinence.
Treatment starts by confirming the type of prolapse and understanding bowel function. Evaluation may include a history, anorectal examination, assessment while straining, and evaluation of anal sphincter function.
Selected patients may need:
Not every patient needs every test. Read the detailed guide to rectal prolapse testing.
Rectal prolapse can coexist with both constipation and fecal incontinence.
Some patients experience improved bowel control after the prolapse is corrected, particularly when the prolapse has been interfering with anal closure. Improvement is not guaranteed, and longstanding sphincter or nerve dysfunction may persist.
Constipation may also change after surgery. Preoperative bowel-function assessment is important because different operations can affect evacuation differently.
Learn more about fecal incontinence evaluation and treatment.
Recovery depends on the operation, abdominal versus perineal route, minimally invasive versus open technique, overall health, baseline bowel function, and whether another pelvic-floor procedure is performed.
Postoperative instructions may address:
Bowel function may continue to change after the prolapse has been repaired. Review rectal prolapse surgery recovery.
Recurrence is possible after any prolapse operation. Risk varies according to the type of repair, prolapse anatomy, previous prolapse surgery, pelvic-floor function, tissue support, constipation, straining, and other patient-specific factors.
A durable treatment plan addresses both the prolapse and associated bowel dysfunction. No responsible treatment page should promise a permanent cure for every patient.
Most repairs are planned rather than performed as emergencies. Seek urgent medical care when:
A prolapse trapped outside the anus can lose its blood supply. Read when rectal prolapse may be an emergency.
If rectal prolapse repeatedly protrudes, requires manual reduction, causes bleeding or mucus drainage, or affects bowel control and daily activities, a colorectal surgical evaluation can clarify the options.
Aisha Akhtar, MD, FASCRS, FACS is a board-certified colon and rectal surgeon who evaluates and treats rectal prolapse and related colorectal and pelvic-floor conditions for patients in Phoenix, Scottsdale, Glendale, and surrounding Arizona communities.
Treatment is individualized according to prolapse anatomy, bowel function, health status, previous surgery, operative risk, and patient goals.
Schedule a Rectal Prolapse Evaluation or call 602-932-5660.
For symptomatic full-thickness rectal prolapse in adults, surgery is generally the definitive treatment. The best operation depends on prolapse anatomy, bowel function, overall health, previous surgery, operative risk, and patient goals.
Full-thickness prolapse does not usually correct itself with fiber, laxatives, or pelvic-floor therapy. These measures may improve constipation, straining, irritation, or other associated symptoms.
Common options include abdominal rectopexy and perineal procedures such as perineal rectosigmoidectomy or the Delorme procedure. The operative approach is individualized.
Rectopexy may be performed with laparoscopic or robotic techniques when appropriate. The surgical route depends on anatomy, previous surgery, medical condition, and surgeon judgment.
Bowel control may improve after the prolapse is corrected, but the result varies. Longstanding sphincter or nerve dysfunction may persist and require additional management.
Yes. Bowel function can change after rectal prolapse surgery, and some techniques may be more suitable than others when significant constipation is present. This is one reason bowel function is assessed before surgery.
This page was developed for patient education under the authorship of Dr. Aisha Akhtar, MD, FASCRS, FACS, a board-certified colon and rectal surgeon.
Content updated: September 7, 2026
Clinical review: Pending approval by Dr. Aisha Akhtar before publication
This page provides general educational information and does not replace an individualized medical examination, diagnosis, or treatment recommendation.
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