Rectal Prolapse Repair: Surgery, Recovery & Pelvic Floor Support

What Is Rectal Prolapse Repair Surgery?

Rectal prolapse occurs when weakened pelvic floor muscles and supporting tissues allow the rectum to slip downwards and protrude through the anus. This condition can affect both men and women and is often associated with chronic straining, constipation, pelvic floor weakness, ageing, childbirth or increased pressure on the pelvic floor.

Symptoms may include bowel leakage, difficulty emptying the bowels, pelvic pressure, discomfort or a visible protrusion from the anus.

Rectal prolapse repair surgery aims to restore the rectum to its normal position and improve bowel support and function. Unlike many pelvic organ prolapse surgeries, rectal prolapse surgery may be performed through the abdomen or via the anus and perineum, depending on the severity of the prolapse, your symptoms and overall health.

Pelvic floor rehabilitation and bowel management are also important parts of recovery and long-term pelvic health support following rectal prolapse treatment.

Is Rectal Prolapse Surgery Right for You?

If you think you may have a rectal prolapse, it is important to seek medical advice early. While rectal prolapse is not usually life-threatening, symptoms can worsen over time and may significantly affect bowel function, comfort and quality of life.

Some people experience a prolapse only during bowel movements, where the rectum can return inside on its own or be gently pushed back. In more advanced cases, the prolapse may remain permanently outside the anus, known as an external rectal prolapse.

Symptoms may include:

• Bowel leakage or faecal incontinence
• Difficulty controlling wind
• Constipation and excessive straining
• Pelvic pressure or discomfort
• A visible protrusion from the anus

Because rectal prolapse is often linked to pelvic floor weakness and chronic straining, conservative treatment is usually recommended first, particularly for milder internal prolapse.

Conservative Treatment Before Surgery

Many people can improve symptoms and help prevent worsening by:

• Strengthening the pelvic floor muscles
• Managing constipation and reducing straining
• Increasing fibre and fluid intake
• Using bowel management strategies
• Maintaining a healthy weight
• Supporting pelvic floor rehabilitation with devices such as Kegel8

Your doctor may also recommend stool softeners or bulking laxatives to help make bowel movements easier and reduce pressure on the pelvic floor.

Surgery is generally considered when symptoms are severe, the prolapse is external or permanently visible, or conservative treatments have not provided enough relief.

What Types of Rectal Prolapse Surgery Are Available?

The type of rectal prolapse repair surgery recommended will depend on:

• Your age and general health
• The severity of the prolapse
• Whether other pelvic floor conditions are present
• Your surgeon’s experience and preferred surgical approach

Abdominal Rectal Prolapse Surgery

Some procedures are performed through the abdomen using either open surgery, laparoscopic (keyhole) surgery or robotic-assisted techniques. These procedures aim to restore rectal support and may have lower recurrence rates in some patients.

Minimally invasive techniques, such as laparoscopic or robotic surgery, may offer:

• Smaller incisions
• Faster recovery
• Less post-operative discomfort
• Reduced scarring

However, not all patients are suitable candidates for these approaches.

Perineal or Anal Rectal Prolapse Surgery

In older adults or those with significant medical conditions, surgery may sometimes be performed through the anus or perineum. These procedures are often less invasive and may involve a quicker recovery, although recurrence rates can sometimes be higher.

Types of Rectal Prolapse Surgery

The type of rectal prolapse repair surgery recommended will depend on your symptoms, overall health, age and the severity of the prolapse. Your surgeon will discuss the most suitable option for your individual needs.

Rectopexy

Rectopexy is one of the most common surgeries used to repair rectal prolapse. The procedure is usually performed through the abdomen using either open surgery, laparoscopic (keyhole) surgery or robotic-assisted techniques.

During surgery, the rectum is carefully lifted back into its normal position and secured to the pelvis (sacrum) to improve support and reduce prolapse recurrence. In some cases, part of the bowel may also be removed if chronic constipation or bowel damage is contributing to symptoms.

Some surgeons may use mesh reinforcement to provide additional support, although the use of surgical mesh remains carefully assessed and may not be suitable for everyone.

Rectopexy generally has good long-term success rates and a relatively low recurrence risk. However, some people may still experience ongoing bowel symptoms such as constipation, straining or faecal leakage after surgery.

Perineal Rectal Prolapse Surgery

For older adults or people with additional medical conditions, surgery may sometimes be performed through the anus or perineum rather than through the abdomen.

Common procedures include:

• Altemeier Procedure — excess prolapsed rectal tissue is removed and the bowel is rejoined lower down.
• Delorme Procedure — used for shorter prolapses, where the rectal lining is removed and the rectum tightened and shortened to improve support.

In some cases, the pelvic floor muscles may also be tightened during surgery to help improve bowel control and pelvic support.

Anal Encirclement Procedures

Less commonly, a procedure called anal encirclement (Thiersch procedure) may be performed. This involves placing a supportive band around the anus to help prevent prolapse recurrence. Because this approach does not address the underlying pelvic floor weakness and can lead to complications, it is now used less frequently.

Risks and Possible Complications

As with any pelvic floor surgery, rectal prolapse repair carries potential risks and complications. These may include:

• Bleeding or infection
• Constipation or bowel obstruction
• Recurrence of the prolapse
• Faecal incontinence
• Damage to surrounding pelvic tissues or nerves
• Pain or narrowing of the anal canal
• Problems with bowel emptying
• Rare risks associated with anaesthesia or blood clots

Your surgeon will discuss these risks with you and explain the benefits and alternatives before surgery.

Recovery After Rectal Prolapse Surgery

Recovery times vary depending on the type of surgery performed and your overall health. Most people recover within 4–6 weeks, although bowel function and pelvic floor recovery may continue to improve over several months.

Following surgery, you may be advised to:

• Avoid heavy lifting and straining
• Follow a bowel-friendly diet
• Stay hydrated
• Use stool softeners or laxatives if needed
• Gradually return to activity
• Begin pelvic floor rehabilitation

Supporting Recovery and Preventing Recurrence

Pelvic floor rehabilitation is an important part of both rectal prolapse recovery and long-term prevention.

Even after surgery, weakened pelvic floor muscles can continue to contribute to bowel symptoms and recurrence risk. Pelvic floor exercises and NMES pelvic floor stimulation with Kegel8 may help strengthen and retrain the pelvic floor muscles, improve pelvic support and support bowel control during recovery.

Lifestyle changes can also help reduce pressure on the pelvic floor and support healing, including:

• Managing constipation and avoiding straining
• Increasing fibre and fluid intake
• Maintaining a healthy weight
• Using a toilet stool to improve bowel positioning
• Wearing pelvic support garments where appropriate

Kegel8 pelvic floor rehabilitation programmes can help support pelvic floor strength before and after rectal prolapse surgery, helping you take a proactive role in your long-term pelvic health and recovery.

Sources

American Society of Colon and Rectal Surgeons. (2024). Diseases and Conditions. Rectal Prolapse Expanded Version. [online] American Society of Colon and Rectal Surgeons,  [viewed 22/10/2024]. Available from: https://fascrs.org/patients/diseases-and-conditions/a-z/rectal-prolapse-expanded-version

Baig, M. K. Maddiba, T. E. Wexner, S. D. (2005). Archives of Surgery / JAMA Surgery. Surgical management of rectal prolapse. [online] 140(1), p 63-73. [viewed 22/10/2024]. Available from: https://pubmed.ncbi.nlm.nih.gov/15655208/

Hull and East Yorkshire Hospitals NHS Trust. (2017). Patients Leaflets: Colonoscopy. [online] Hull and East Yorkshire Hospitals NHS Trust, 2017 [viewed 22/10/2024]. Available from: https://www.hey.nhs.uk/patient-leaflet/colonoscopy-2/

NHS North Tees & Hartlepool 18th March 2024 Rectal Prolapse: Altemeier's Procedure, rectal prolapse repair [viewed 22/10/2024].

NHS North Tees & Hartlepool: October 2023 Delorme's Procedure [viewed 22/10/2024]. Rectal prolapse surgery patient information.

Exploring the Thiersch Method in Complicated Cases Editors: Alexander Muacevic, John R Adler (2024) [viewed 22/10/2024]

Mayo Clinic July 25th 2023 Rectal Prolapse Surgery [viewed 22/10/2024]. 

Laparoscopic Suture Rectopexy June 2024 NHS University Hospitals Plymouth [viewed 22/10/2024] The most common reason for a Laparoscopic Suture Rectopexy, or otherwise known as Laparoscopic Posterior Suture Rectopexy (‘LPSR’ for short) is to repair an external rectal prolapse (bowel coming out through the anus). Another reason for surgery is internal prolapse or “intussusception” when the rectum ‘telescopes’ in on itself, without coming out of the anus.