Rectal prolapse repair (rectopexy)

What is rectal prolapse repair (rectopexy)?

A full-thickness rectal prolapse is where the rectum (the last part of the bowel) loses its normal support and slips down, turning inside out and coming through the anus. It can cause a lump, mucus, bleeding, difficulty controlling the bowel (leakage) and difficulty emptying. It is most common in older women but can affect anyone.

Surgery aims to put the rectum back in place and stop it slipping again. There are two broad approaches. An abdominal operation (rectopexy) is usually done by keyhole (laparoscopic) or robotic surgery and lifts and fixes the rectum, often using a piece of mesh placed at the front (ventral mesh rectopexy); a stitch-only version is sometimes used. A perineal operation is done through the back passage without a tummy cut, and includes the Delorme procedure (removing and refolding the lining) or the Altemeier procedure (removing the prolapsed segment); these are often chosen for frailer people because they avoid abdominal surgery.

Surgery usually corrects the prolapse, but it does not always fully fix bowel-control problems (leakage) or difficulty emptying (constipation), which can take time to settle and sometimes persist. The right operation depends on your fitness, your symptoms, and the trade-off between recurrence risk and the risks of bigger surgery — so this is a shared decision with your surgeon.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Abdominal vs perineal repair

Neither approach is automatically best. Abdominal repair generally has a lower recurrence rate; perineal repair avoids a tummy operation and may suit frailer people. A large UK trial (PROSPER) did not show a clear difference in recurrence between some approaches. The choice depends on your fitness, symptoms and preferences.

Preparing for your surgery

• See the operating surgeon to confirm the diagnosis and discuss which operation suits you and why.
• Have any recommended tests, such as examination, bowel imaging or tests of bowel function, beforehand.
• Tell the team about all medicines, especially blood thinners, and about other health problems and your general fitness.
• Discuss your main goal — fixing the lump, improving leakage, or easing difficulty emptying — as this can influence the choice of operation.
• Stop smoking beforehand if you can, to lower wound and healing risks.
• Follow any bowel-preparation and fasting instructions for your operation.
• Arrange a lift home and help at home; plan time off (often 2–6 weeks depending on the approach).

What happens

Abdominal rectopexy is usually done under general anaesthetic by keyhole or robotic surgery, through a few small cuts. The surgeon lifts the rectum back into place and fixes it, either with a piece of mesh at the front (ventral mesh rectopexy) or with stitches; sometimes a segment of bowel is removed and the ends joined. It usually takes a couple of hours, and many people stay a night or two.

A perineal operation is done through the back passage with no tummy cut, sometimes under a spinal anaesthetic. In the Delorme procedure the prolapsed lining is removed and the muscle refolded; in the Altemeier procedure the prolapsed segment is removed and the ends joined. These often involve a shorter operation and stay.

Afterwards you recover on a ward and are encouraged to move early. You will be given advice on bowel habit, avoiding straining and when to build up activity. Any removed tissue can be examined in the laboratory if needed.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

Surgery usually corrects the prolapse, but it may not fully fix leakage or difficulty emptying, and the prolapse can come back. If mesh is used, ask specifically about mesh-related risks and how problems would be handled, as mesh in pelvic surgery has drawn safety concerns. If an operation involves removing a segment of bowel and joining it, a leak is a serious but uncommon risk. Recurrence and complication rates vary by operation and by how fit you are.

Published figures to discuss

Recurrence and complication rates vary by operation, by how fit you are, and by surgeon and unit experience. The figures below are cautious ranges from surgical studies, not guarantees for any one person. A large UK trial (PROSPER) did not show a clear difference in recurrence between some abdominal and perineal approaches.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery depends on the operation. Perineal repairs and keyhole abdominal repairs often mean a short stay and a recovery of a few weeks. Bowel control and any constipation can take longer — weeks to months — to settle, and may not fully resolve.

• Unsettled bowel habit, including constipation or looser stools, that gradually improves
• Some bleeding or discharge from the back passage after perineal repair
• Tiredness for a week or two that lifts
• Soreness around the wounds or back passage
• A feeling of needing to empty that eases as healing progresses

Aftercare

• Take painkillers as advised and keep moving little and often to lower clot risk.
• Use stool softeners or fibre as advised and avoid straining while you heal.
• Build up activity gradually and avoid heavy lifting until your surgeon says it is safe.
• Keep wounds clean and dry and follow advice on showering and dressings.
• Drink plenty of fluids and eat a balanced diet to keep stools soft.
• Do not drive until you can brake hard comfortably, are off strong painkillers and your insurer agrees.
• Watch for warning signs such as fever, heavy bleeding or severe pain.
• Keep follow-up appointments and report any return of the prolapse or ongoing bowel problems.

• Painkillers and any recommended stool softeners or fibre in stock
• Plenty of fluids and a balanced diet planned
• Help arranged at home for the first days
• Loose, comfortable clothing
• Time off work booked (often 2–6 weeks depending on the operation)
• Knowledge of warning signs (fever, heavy bleeding, severe pain)
• The clinic's contact number saved for problems

Scars and how they heal

Keyhole or robotic abdominal repair leaves a few small scars on the tummy that fade over months. Perineal operations (Delorme, Altemeier) are done through the back passage and leave no external tummy scar. Scars are pink and firm at first and usually settle well.

⚠ Get urgent help if…

• A high temperature, shivering or feeling very unwell (possible infection)
• Heavy bleeding from the back passage or a wound
• Severe or worsening tummy or back-passage pain
• A hard, swollen, tender tummy or being unable to pass wind or stool (possible blockage)
• New, offensive discharge or pain that could suggest a mesh problem (if mesh was used)
• A swollen, hot or painful calf, or breathlessness or chest pain (possible clot — call 999)
• The prolapse coming back through the anus

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

For most people, surgery successfully puts the rectum back in place and stops it coming through the anus, which relieves the lump, mucus and bleeding. Many people also notice improved bowel control over time.

Surgery does not guarantee that leakage (incontinence) or difficulty emptying (constipation) will fully resolve, and these can take months to settle or may persist; sometimes extra measures such as pelvic-floor exercises, diet changes or specialist input help. The prolapse can also come back, with recurrence generally lower after abdominal repair and reported across a wider range after some perineal operations. A good surgeon is clear about what the operation can and cannot fix in your case.

Most repairs last well, but no operation removes the chance of recurrence. Abdominal rectopexy generally has a lower recurrence rate over the years, while some perineal operations have higher reported recurrence; being male or older than 80 has been linked to a higher chance of recurrence after ventral mesh rectopexy. If the prolapse comes back, a further operation may be possible. Bowel function usually settles into a manageable pattern, though it may not be exactly as before, and ongoing problems should be reviewed.

Combining with other procedures

Rectal prolapse often goes along with other pelvic-floor problems, such as a prolapse of the vagina or bladder, and these are sometimes assessed and treated together by a pelvic-floor team. An abdominal rectopexy is occasionally combined with removing a segment of bowel (resection rectopexy) when constipation is a major issue. You should not feel pressured into unrelated add-on procedures.

Follow-up & long-term care

You will usually be reviewed after surgery to check healing and how your bowel is working. Because prolapse and bowel-function problems can be linked, you should have a route back to the team if leakage or constipation does not improve, or if the prolapse returns. If mesh was used, you should be told what to look out for and who to contact if you have concerns about it.

• Keep stools soft with fluids, diet and any recommended fibre or softeners to avoid straining.
• Do pelvic-floor exercises if advised, to support bowel control.
• Report any return of the prolapse, or ongoing leakage or constipation, for review.
• If mesh was used, seek advice promptly for new pelvic pain, bleeding or discharge.
• Build back up to normal activity and lifting gradually after surgery.

Revision and secondary surgery reality

• The prolapse can recur and may need a further operation, sometimes by a different approach.
• If mesh causes problems, further surgery to deal with it may be needed.
• An operation that removes a segment of bowel adds the risk of an anastomotic leak needing further treatment.
• Ongoing leakage or constipation may need extra measures rather than more prolapse surgery.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• Clear advice on keeping stools soft, avoiding straining, and building up activity.
• A named contact and out-of-hours number, with clear warning signs for infection, bleeding or recurrence.
• Review of bowel function, with onward referral (for example pelvic-floor physiotherapy) if leakage or constipation persists.
• If mesh was used, clear information on what to watch for and who to contact about mesh concerns.
• A clear plan if the prolapse comes back.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The type of operation (abdominal keyhole/robotic versus perineal) and its complexity
• Whether mesh is used or a segment of bowel is removed
• Surgeon's and anaesthetist's fees
• Theatre/facility time and length of hospital stay
• Pre-operative tests of bowel function and any pelvic-floor assessment
• Follow-up appointments and the policy if a complication or recurrence occurs

• The surgeon's fee and the anaesthetist's fee
• The hospital/facility and theatre fee, and any overnight stay
• Whether mesh and any bowel resection are included, and what mesh is used
• Pre-operative tests and any pelvic-floor assessment
• Follow-up appointments and review of bowel function
• The cancellation policy
• What happens, and who pays, if the prolapse recurs or a complication occurs

On the NHS? Rectal prolapse repair is widely available on the NHS when the prolapse causes symptoms; private care may be chosen for speed or choice of surgeon.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Which operation do you recommend for me — abdominal or perineal — and why?
• Will mesh be used, and if so what are its specific risks and what happens if there is a problem?
• How likely is the prolapse to come back with the operation you suggest?
• How likely is my leakage or constipation to improve, and what else can help?
• Could I have other pelvic-floor problems that should be assessed at the same time?
• What is the recovery, and who do I contact if I have problems afterwards?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for rectal prolapse repair (rectopexy)

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: Rectal prolapse surgery: balancing effectiveness and safety in abdominal and perineal approaches (PMC) Best approaches to rectal prolapse — review (Annals of Laparoscopic and Endoscopic Surgery) Predictive factors for recurrence after laparoscopic ventral rectopexy (PMC) Perineal rectosigmoidectomy for rectal prolapse in the unfit elderly — UK tertiary centre (PubMed) NHS — Pelvic organ prolapse

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.