Stapled transanal rectal resection (STARR)

What is stapled transanal rectal resection (STARR)?

STARR is an operation done through the back passage (transanally), with no cut on the tummy, using a circular stapling device. It removes a section of the lower rectum and is used for a specific problem called obstructed defaecation syndrome (ODS) — difficulty emptying the bowel — when this is caused by particular changes in the rectum, namely a rectocele (a bulge of the front rectal wall) and/or an internal prolapse (intussusception, where the rectum folds in on itself).

By removing the redundant tissue, STARR aims to improve emptying so that you no longer need to strain heavily, press on the area, or use a finger to help empty. It is not a treatment for constipation in general — it is only for carefully selected people whose difficulty emptying is shown to be caused by a rectocele or internal prolapse, after specialist assessment.

NICE has reviewed STARR and concluded the evidence on safety and efficacy is adequate for use with normal arrangements for consent and audit. It can help, but results vary, symptoms can return over time, and urgency (a sudden need to empty) is common early on. It should be considered only after non-surgical measures and proper investigation, as part of a shared decision.

Types & techniques

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

STARR vs non-surgical treatment

Non-surgical measures (diet, fluids, bowel retraining, pelvic-floor physiotherapy, sometimes biofeedback) are usually tried first. STARR is for selected people whose difficulty emptying is shown to be caused by a rectocele or internal prolapse and who have not improved with these measures.

Preparing for your surgery

• See a colorectal specialist to confirm that a rectocele or internal prolapse is causing your difficulty emptying, with the right tests (such as proctography and bowel-function assessment).
• Make sure non-surgical measures (diet, fluids, bowel retraining, pelvic-floor physiotherapy) have been properly tried first.
• Discuss your symptoms honestly, including any urgency, leakage or previous pelvic-floor surgery, as these affect suitability and outcome.
• Tell the team about all medicines, especially blood thinners, and about other health problems.
• Stop smoking beforehand if you can, to lower healing risks.
• Follow any bowel-preparation and fasting instructions for your operation.
• Arrange a lift home and plan time off (often 1–3 weeks).

What happens

STARR is done under general or spinal anaesthetic and usually takes about 30 to 60 minutes. There is no cut on the tummy. The surgeon places a device in the back passage and uses one or more circular staplers to remove a section of the redundant lower rectum (from the front and/or back), closing the area with rows of staples at the same time.

The aim is to correct the rectocele and/or internal prolapse so that emptying is easier. The removed tissue can be examined in the laboratory. Most people stay as a day case or for one night, going home once comfortable, able to pass urine and with their pain controlled.

It is normal to feel a strong, frequent urge to empty (urgency) in the first days to weeks, as the lower rectum has been operated on; this usually settles. You will be given advice on pain relief, keeping stools soft and what to expect.

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.

Early urgency is very common and usually settles, but a small number of people have lasting urgency, ongoing pain, or symptoms that do not improve or return. Rare but serious complications include a connection forming between the rectum and vagina (fistula). Results are poorer in people who have had previous pelvic-floor surgery. STARR is not a treatment for general constipation, so careful selection after proper investigation is essential — ask what happens if it does not work for you.

Published figures to discuss

The figures below come from case series and the NICE review of STARR for obstructed defaecation syndrome with rectocele and intussusception. They are cautious and source-defensible, but they come from selected patients in specialist settings, so they may not reflect every person's result. Early urgency is common and usually improves over the first year.

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 from STARR is usually a few weeks. Most people go home the same day or after one night. A frequent or sudden urge to empty is common in the first days to weeks and usually settles over the following weeks to months.

• A frequent or sudden urge to empty (urgency) in the early weeks that usually settles
• Back-passage discomfort for a week or two
• Some bleeding from the back passage after surgery
• Unsettled bowel pattern that gradually improves
• Needing stool softeners for a time to avoid straining

Aftercare

• Take painkillers as advised and use any recommended stool softeners to keep stools soft.
• Drink plenty of fluids and eat a balanced diet to avoid straining.
• Build up activity gradually and avoid heavy lifting until your surgeon says it is safe.
• Expect early urgency and avoid rushing; it usually settles over weeks.
• Keep the area clean and follow advice on bathing.
• 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, severe pain or passing wind/stool from the vagina.
• Keep follow-up appointments and report any ongoing or returning symptoms.

• Painkillers and any recommended stool softeners in stock
• Plenty of fluids and a balanced diet planned
• Someone to drive you home
• Loose, comfortable clothing
• Time off work booked (often 1–3 weeks)
• Knowledge of warning signs (fever, heavy bleeding, severe pain, wind/stool from the vagina)
• The clinic's contact number saved for problems

Scars and how they heal

STARR is done through the back passage, so there is no external scar. Inside, there is a circular line of staples in the lower rectum where the tissue was removed and rejoined.

⚠ Get urgent help if…

• A high temperature, shivering or feeling very unwell (possible infection or sepsis)
• Heavy or persistent bleeding from the back passage
• Severe or worsening pain in the back passage or pelvis
• Passing wind, fluid or stool from the vagina (possible fistula) — seek help promptly
• Being unable to pass urine
• Being unable to empty the bowel at all, with a swollen tummy
• Spreading redness, swelling or offensive discharge

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

In carefully selected people, STARR can improve difficulty emptying caused by a rectocele or internal prolapse, reducing straining and the need to press on the area or use a finger to empty. Studies report that many people improve in the first year, though results vary between individuals and over time.

STARR does not treat constipation in general, and it cannot guarantee that emptying will be normal or that symptoms will not return. Early urgency is common and usually settles, but a minority have lasting urgency or ongoing symptoms, and outcomes are poorer after previous pelvic-floor surgery. A good surgeon is clear about how likely it is to help you specifically, and what the options are if it does not.

STARR can give lasting improvement for some people, but symptoms of obstructed defaecation can return over time, and the underlying tendency to a pelvic-floor problem remains. Longer-term studies show more variable results than the early period, especially in people with previous pelvic-floor surgery. If symptoms return, further assessment is needed to decide on the next step, which may be non-surgical measures or, occasionally, another procedure.

Combining with other procedures

Obstructed defaecation is often part of a wider pelvic-floor problem, and you may be assessed by a pelvic-floor team alongside checks for other issues (such as a vaginal or bladder prolapse). STARR is not usually combined with unrelated procedures, and decisions about doing more than one thing at once should be made carefully with a specialist team. You should not feel pressured into add-on procedures.

Follow-up & long-term care

You should be reviewed after surgery to check healing and how your bowel is emptying, and to discuss any laboratory (pathology) result from the removed tissue. Because results vary and symptoms can return, you should have a clear route back to the team if urgency, pain or difficulty emptying persists or comes back. You should be told what to watch for, including the rare but serious sign of passing wind or stool from the vagina.

• Keep stools soft with fluids, diet and any recommended fibre or softeners to avoid straining.
• Continue bowel retraining and pelvic-floor exercises if advised.
• Report any return of difficulty emptying, new urgency or pain for review.
• Seek help promptly for any sign of passing wind or stool from the vagina.
• Build back up to normal activity and lifting gradually after surgery.

Revision and secondary surgery reality

• Symptoms can persist or return, and reassessment is needed to decide the next step.
• A narrowing (stricture) at the staple line may need stretching.
• Occasionally a further procedure is considered if symptoms recur, after specialist review.
• A rare rectovaginal fistula would need specialist surgical treatment.

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, managing early urgency and avoiding straining.
• A named contact and out-of-hours number, with clear warning signs including passing wind or stool from the vagina.
• Review of bowel function, with pelvic-floor physiotherapy or specialist input if symptoms persist.
• A clear plan and reassessment if symptoms do not improve or return.
• Explanation of any laboratory (pathology) result from the removed tissue.

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 specific technique and stapling device used
• Surgeon's and anaesthetist's fees
• Theatre/facility time and whether an overnight stay is needed
• Pre-operative investigations (such as proctography and bowel-function tests)
• Pelvic-floor assessment and any physiotherapy
• Follow-up appointments and the policy if symptoms persist or a complication occurs

• The surgeon's fee and the anaesthetist's fee
• The hospital/facility and theatre fee, and any overnight stay
• Pre-operative investigations and pelvic-floor assessment
• The stapling device used
• Follow-up appointments and review of bowel function
• The cancellation policy
• What happens, and who pays, if symptoms do not improve or a complication occurs

On the NHS? STARR may be available on the NHS in selected cases after specialist assessment, usually once non-surgical measures have been tried; access can vary by area, and 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.

• Is my difficulty emptying definitely caused by a rectocele or internal prolapse, and what tests confirm it?
• Have I properly tried non-surgical measures first, and could they still help?
• How likely is STARR to help my specific symptoms, and how long might the benefit last?
• What are the risks in my case, including urgency and the rare risk of a fistula?
• Have I had previous pelvic-floor surgery, and does that affect my chances?
• What happens, and what are my options, if STARR does not work or symptoms return?
• 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 stapled transanal rectal resection (starr)

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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: NICE IPG351 — Stapled transanal rectal resection for obstructed defaecation syndrome NICE IPG351 — the procedure (efficacy and safety) STARR for obstructed defecation with rectocele and intussusception — 12-month outcomes (PMC) STARR for obstructive defaecation: poorer long-term outcome after previous pelvic-floor surgery (PubMed) STARR for obstructed defaecation syndrome — review (PubMed)

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.