Rectal Prolapse

Rectal prolapse occurs when the rectum — the final part of the large bowel — loses its normal attachments inside the pelvis and slides outward through the anal opening. It is more common in women and in older adults, but affects people of all ages.

The prolapse can be partial (involving only the inner lining, or mucosa) or full-thickness, where the entire wall of the rectum protrudes. Your surgeon will assess which type you have, as this helps guide the most appropriate treatment.

Rectal prolapse may allow your surgeon to:

• Confirm the type and severity of your prolapse
• Assess your pelvic floor and bowel function
• Identify the safest and most effective surgical approach for you
• Plan recovery and any additional support such as pelvic floor physiotherapy

Symptoms vary in severity and may worsen gradually over months or years. Many patients find they significantly improve — or resolve entirely — after surgery. You may experience one or more of the following:

• Tissue or a lump protruding from the back passage, particularly after straining or opening the bowels
• Difficulty controlling bowel movements (faecal incontinence)
• Mucus discharge or bleeding from the back passage
• A sensation of incomplete emptying after opening the bowels
• Discomfort, pressure, or a dragging sensation in the pelvis
• Needing to push tissue back manually after passing a bowel motion
• Urgency — a sudden, strong need to open the bowels — or occasional accidents

There is no single best operation for rectal prolapse. The right choice depends on your overall health, medical history, bowel function, and personal priorities. Your fitness directly influences which approach is safest and most effective for you.

Before recommending any operation, Mr Chaudhri will assess your general health in detail, including:

• Heart and lung function
• Any chronic medical conditions (diabetes, kidney disease, previous surgery)
• Current medications, particularly blood thinners or diabetes medications
• Your body weight and overall activity level
• Previous abdominal or pelvic surgery that may affect surgical access

Surgery for rectal prolapse is carried out by one of two routes — through the abdomen, or through the perineum (the area around the back passage). The route chosen depends primarily on your fitness, the size of your prolapse, and your bowel function.

Abdominal Approach: Rectopexy

In a rectopexy, the rectum is carefully freed from its surrounding tissues inside the pelvis, lifted back to its correct anatomical position, and secured to the lower spine (sacrum) using sutures or a mesh. This is performed through small keyhole incisions in the abdomen.

Robotic or Laparoscopic Rectopexy — Mr Chaudhri performs this operation using a robotic platform, which provides enhanced precision and three-dimensional vision within the confined pelvic space. This is particularly valuable in patients with a narrow pelvis or complex anatomy.

• Lowest recurrence rate of all surgical options (~5–10%)
• Keyhole surgery — small incisions, faster recovery
• Hospital stay typically 1–3 days
• Return to light activity within 2–4 weeks
• Requires general anaesthetic
• Best suited to patients with good to moderate fitness

Suture Rectopexy (Mesh-Free Option) — Rectopexy can be performed using sutures alone, avoiding synthetic mesh entirely. This is preferred if you have had previous pelvic floor surgery, pelvic radiation, or specific concerns about mesh implants.

Resection Rectopexy — If you also have significant constipation, the redundant sigmoid colon may be removed at the same time. This combined operation addresses both the prolapse and the constipation in a single procedure, but requires a longer hospital stay of 3–5 days.

Perineal Approach: Delorme and Altemeier Procedures

Perineal operations are performed entirely through the back passage — no abdominal incisions are made. This significantly reduces the physiological demand on the body and means these procedures can usually be carried out under spinal anaesthesia, making them suitable for patients who are not fit for a general anaesthetic or abdominal surgery.

The Delorme Procedure — The inner lining (mucosa) of the prolapsed bowel is carefully stripped away. The underlying muscle is then folded together (plicated) to create a thicker, more supportive wall, and the wound is closed. Best suited to smaller or moderate prolapse.

• No abdominal incisions
• Can be performed under spinal anaesthesia
• Hospital stay typically 2–4 days
• Recurrence rate ~15–25%
• Best for high-risk or frail patients with smaller prolapse

The Altemeier Procedure (Perineal Rectosigmoidectomy) — The full thickness of the prolapsed bowel is removed through the perineum, and the remaining bowel is rejoined to the anal canal. This approach is used for larger prolapse or where the Delorme procedure would be insufficient. It can be combined with a pelvic floor repair (levatoroplasty) to improve continence.

• Suitable for larger or recurrent prolapse
• Can be combined with levatoroplasty for continence improvement
• Hospital stay typically 3–5 days
• Recurrence rate ~10–20%
• Best for high-risk patients with significant prolapse

Recovery varies between procedures and between individuals. The guidance below covers what most patients can expect. Mr Chaudhri will give you personalised advice based on your operation and circumstances.

In Hospital

• You will be encouraged to walk on the day of your surgery
• Pain is managed with regular analgesia — most patients find it well controlled
• Diet is reintroduced gradually from the day of or day after surgery
• Bowel function is monitored by the nursing team
• Hospital stay is typically 1–5 days depending on the operation performed
• Mr Chaudhri will visit to discuss the outcome of your surgery before you go home

The First Two Weeks at Home

• Rest at home and take gentle walks — avoid strenuous activity, heavy lifting, and driving
• Take stool softeners as prescribed to avoid straining
• For perineal procedures, keep the wound area clean and dry
• Use moist, fragrance-free wipes if you find these more comfortable
• Apply a barrier cream around the back passage if there is any skin soreness
• Contact the clinic if you have concerns about your wound, pain, or bowel function

Weeks 3–6

• Gradual return to normal activities as your energy and comfort allow
• Bowel function often continues to improve throughout this period
• Outpatient follow-up appointment with Mr Chaudhri to review your recovery
• Pelvic floor physiotherapy is often recommended at this stage

Six Weeks and Beyond

• Most patients return to full activity by six weeks
• Improvement in incontinence may continue gradually for several months
• Written results of any biopsies taken will be sent to you within 2–4 weeks
• Further follow-up will be arranged if needed

Surgery for rectal prolapse is generally very safe and serious complications are uncommon. However, as with any surgical procedure, there are potential risks that Mr Chaudhri will discuss with you in full at your consultation and at the time of obtaining your consent.

There are no wrong questions. The goal of your consultation is for you to leave with a clear, personalised plan that you feel confident about. You may find it helpful to bring this list with you:

• Which operation do you recommend for me specifically, and why?
• How does my current health affect the choice of procedure?
• What are the risks most relevant to my situation?
• What is the chance of the prolapse coming back after surgery?
• Will surgery improve my incontinence or constipation?
• Will mesh be used? What are the alternatives?
• How long will I be in hospital and what is my expected recovery time?
• What happens if I choose not to have surgery at this stage?
• Will I need pelvic floor physiotherapy before or after the operation?
• What results have you personally seen with the operation you are recommending?