Rectal Prolapse Treatment & Surgery
Rectal prolapse is frequently mistaken for piles — including by doctors — and treated for years with creams that were never going to work. It is a structural problem: the rectum has lost its attachments and is telescoping out. Our colorectal surgeons repair it, most often through keyhole surgery, with home the next day and a real end to the daily embarrassment.
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What is Rectal Prolapse?
Rectal prolapse is the rectum — the last section of the large bowel — losing its normal attachments and telescoping down and out through the anus. In a full-thickness prolapse the entire wall of the rectum comes out, appearing as a red, moist, tube-shaped protrusion with visible circular rings on its surface.
Start with the confusion that costs people years: rectal prolapse is routinely mistaken for piles. Both present as something coming out of the back passage, and patients are frequently given creams, suppositories and even haemorrhoid procedures for a condition none of those will ever touch. The difference is visible to anyone who looks properly. Prolapsed piles appear as separate purple lobes with grooves between them; a rectal prolapse is a single continuous tube with concentric circular rings. If you have been treated for piles for years without improvement, ask specifically whether this has been considered.
Understanding why it happens explains who gets it. The rectum is held in place by supporting ligaments and by the pelvic floor muscles. Chronic straining — from constipation, from long-standing diarrhoea, from years of childbirth-related pelvic floor injury, or simply from ageing tissue — gradually stretches and weakens those supports until the rectum begins to descend. It affects two distinct groups: older women, who make up the large majority, and a smaller group of younger patients, often with lifelong severe constipation, psychiatric medication effects or a congenitally deep pelvic pouch.
There is an important distinction to draw. External prolapse comes visibly outside the body. Internal prolapse — also called internal intussusception — telescopes within the rectum without emerging, and it presents quite differently: a persistent sense of incomplete emptying, straining, needing to press around the perineum to pass stool, and mucus discharge. It is diagnosed on a defaecating proctogram rather than by looking, and it is frequently missed for years.
Two honest points about treatment. First, surgery is the only definitive treatment. Diet, fibre and pelvic floor exercises help symptoms and are worth doing, but they do not put the rectum back and hold it there — nothing non-surgical does. Second, incontinence and the prolapse are linked but separate. Around half of patients have some degree of faecal incontinence, from the stretched anal sphincter. Surgery corrects the prolapse and incontinence improves in many, but not everyone, and recovery of sphincter function takes months. Anyone promising that surgery will certainly fix both is overpromising.
One emergency to know: if the prolapse comes out and cannot be pushed back, and becomes swollen, dark or intensely painful, the blood supply may be compromised. That needs same-day hospital assessment.
Treatment information
| Condition | Rectal Prolapse (Complete / Partial / Internal) |
|---|---|
| Procedure | Laparoscopic Ventral Mesh Rectopexy / Perineal Repair |
| Duration | 90 to 150 minutes |
| Treated by | Colorectal / Laparoscopic Surgeon |
| Anaesthesia | General anaesthesia; spinal for perineal procedures |
| Success rate | 85–95% |
| Recovery time | 2 to 4 weeks |
| Hospital stay | 1 to 3 days |
Signs you may need Rectal Prolapse treatment
- A red, moist mass protruding from the anus, with visible concentric circular rings
- Something coming out on straining, initially reducing on its own and later needing to be pushed back
- In advanced cases, a prolapse that stays out all the time
- Mucus discharge staining underwear
- Bleeding from the exposed rectal lining
- Faecal incontinence — leakage of stool, gas or mucus, present in around half of patients
- A constant feeling of incomplete emptying after passing stool
- Straining, and needing to press around the perineum or in the vagina to pass stool
- A sensation of fullness or pressure in the back passage
- Constipation alternating with looseness
- Soreness, itching and skin irritation around the anus
- EMERGENCY: a prolapse that cannot be pushed back and has become swollen, dark or severely painful
What causes it?
- Weakening of the ligaments and fascia that anchor the rectum in the pelvis
- Pelvic floor muscle weakness, often from childbirth injury and ageing
- Chronic constipation and years of straining
- Chronic diarrhoea and prolonged straining from any cause
- An abnormally deep pouch between the rectum and the uterus or bladder
- A loose, mobile sigmoid colon and elongated mesentery
- Previous pelvic or rectal surgery
- Neurological conditions affecting pelvic floor control, including spinal injury and multiple sclerosis
- Cystic fibrosis and severe malnutrition in children
- Whipworm and other parasitic infection in children in endemic areas
Who is more likely to be affected
- Female sex and age above 50 — the large majority of patients
- Multiple vaginal deliveries, particularly with prolonged second stage or instrumental delivery
- Long-standing constipation with habitual straining
- Previous hysterectomy or other pelvic surgery
- Chronic cough or heavy lifting occupations, raising abdominal pressure
- Neurological or spinal disease
- Long-term psychiatric medication causing severe constipation
- Connective tissue disorders
- Malnutrition and low body weight
- Existing pelvic organ prolapse — bladder or uterine
When to see a doctor immediately
- Anything protruding from the anus, whether or not it reduces on its own
- A lump that you have to push back after passing stool
- Mucus discharge or bleeding from the back passage
- Leakage of stool or gas
- A persistent sensation of incomplete emptying despite straining
- Needing to press around the perineum or in the vagina to pass stool
- Being treated for piles for a long period without improvement — ask for the diagnosis to be reviewed
- Any change in bowel habit or bleeding in someone over 45, which needs a colonoscopy regardless
- EMERGENCY, go the same day: a prolapse that will not go back and is swollen, dark or severely painful
How it is diagnosed
Clinical examination with straining
The prolapse frequently does not appear while you lie on a couch, so the examination is done with you straining — sometimes squatting or sitting on a commode. This is the step most often omitted, and it is why prolapse is missed and labelled as piles. Concentric circular rings identify a rectal prolapse; radial grooves identify piles.
Digital rectal examination
Assesses resting and squeeze tone of the anal sphincter, which predicts how much incontinence is likely to persist after repair. It also detects any mass and assesses pelvic floor descent on straining.
Colonoscopy
Performed in all adults, particularly over 45, to exclude a tumour or inflammatory disease acting as a lead point or contributing to the change in bowel habit. Operating on a prolapse without having examined the colon is a mistake.
Defaecating proctogram
Imaging of the rectum during actual defaecation. It is the definitive test for internal prolapse, which never appears externally, and it identifies associated conditions — enterocele, rectocele and pelvic floor dyssynergia — that change the operation planned.
Anorectal manometry
Measures sphincter pressures and rectal sensation objectively. Useful where incontinence is a major complaint, both for planning and for setting realistic expectations about how much will recover.
Endoanal ultrasound
Images the anal sphincter muscles directly and detects defects, often from old obstetric injury. A torn sphincter may need separate attention, and knowing about it beforehand prevents disappointment afterwards.
Assessment of the whole pelvic floor
Rectal prolapse frequently coexists with bladder and uterine prolapse. Examining all three compartments allows a combined repair to be planned in one operation rather than a series of them.
How the options compare
| Feature | Abdominal Repair (Laparoscopic Rectopexy) | Perineal Repair (Altemeier / Delorme) |
|---|---|---|
| Approach | Keyhole through the abdomen | Through the anus, no abdominal incision |
| Anaesthesia | General | Spinal or general |
| Recurrence rate | Low — around 3–8% | Higher — around 15–30% |
| Effect on constipation | Often improves, especially ventral mesh technique | Less predictable |
| Operating time | 90–150 minutes | 60–90 minutes |
| Hospital stay | 1–3 days | 1–2 days |
| Physiological stress | Higher | Lower |
| Best suited to | Fit patients of any age; the default where possible | Frail or elderly patients unfit for abdominal surgery |
| Mesh used | Usually | No |
Types of treatment
Non-surgical measures
Bowel regulation
Adequate fibre, fluid and stool softeners to end straining. This does not cure the prolapse, but it stops it worsening and it is essential both before and permanently after surgery — continued straining is a direct route to recurrence.
Pelvic floor physiotherapy
Supervised pelvic floor training improves sphincter tone and helps incontinence. It also corrects dyssynergia, where the pelvic floor paradoxically tightens during defaecation and drives the straining that caused the problem.
Biofeedback therapy
Retrains coordination between the abdominal muscles and the pelvic floor using visual feedback. Genuinely effective for obstructed defaecation and for the incontinence that accompanies prolapse.
Manual reduction and skin care
Gently pushing the prolapse back after each bowel movement, with barrier cream to protect the skin. A holding measure only, for patients awaiting surgery or unfit for it.
Abdominal surgery
Laparoscopic ventral mesh rectopexy
The current procedure of choice in most centres. A mesh is fixed to the front of the rectum and suspended from the sacrum, lifting it back into position. Because the dissection stays on the front and avoids the nerves behind the rectum, it corrects the prolapse without causing the new constipation that older posterior techniques often did.
Laparoscopic posterior rectopexy
The rectum is mobilised behind and fixed to the sacrum with sutures or mesh. Effective at correcting the prolapse, but it carries a higher chance of worsening constipation because of the nerve dissection involved.
Resection rectopexy
Rectopexy combined with removal of a redundant sigmoid colon. Considered where severe constipation coexists with a very long, loose sigmoid.
Robotic rectopexy
The same operation with articulated instruments and 3D vision, which helps the precise suturing deep in the pelvis. Higher cost, with outcomes comparable to a well-performed laparoscopic repair.
Perineal surgery
Altemeier procedure (perineal rectosigmoidectomy)
The prolapsed segment is removed through the anus and the bowel ends rejoined, with no abdominal incision at all. Suited to frail or elderly patients unfit for abdominal surgery, and to the emergency setting where a prolapse cannot be reduced. Recurrence is higher than after abdominal repair.
Delorme procedure
The lining of the prolapsed segment is stripped and the muscle layer folded and stitched to shorten it. Useful for shorter prolapses and in patients with significant medical comorbidity. Lower risk, higher recurrence.
Thiersch anal encirclement
A band placed around the anus to narrow it and hold the prolapse in. It does not repair anything and carries a real risk of obstruction and erosion. Reserved as a last resort for patients too unwell for any other option.
What happens, step by step
- 1
Assessment and diagnosis
40–60 minutes- Examination with straining, which is essential to see the prolapse at all
- The concentric rings of prolapse distinguished from the radial grooves of piles
- Sphincter tone assessed and any incontinence documented
- Colonoscopy arranged to exclude other colonic disease
- Defaecating proctogram where internal prolapse or obstructed defaecation is suspected
- 2
Pre-operative preparation
1 to 2 weeks- Blood tests, ECG, cardiac and anaesthetic assessment — many patients are older with other conditions
- Anaemia corrected if bleeding has been ongoing
- Bowel preparation as instructed
- Realistic discussion of how much incontinence is likely to improve, and over what timeframe
- Fasting for six to eight hours before surgery
- 3
Laparoscopic ventral mesh rectopexy
90–150 minutes- General anaesthesia; the abdomen is inflated with carbon dioxide
- Four or five keyhole incisions of 5 to 12 mm
- The front of the rectum is dissected down towards the pelvic floor, deliberately avoiding the nerves behind
- A mesh strip is fixed to the front wall of the rectum
- The mesh is suspended from the sacral promontory, lifting the rectum into position
- The peritoneum is closed over the mesh so no bowel can contact it
- Any associated vaginal vault prolapse is addressed in the same operation
- 4
Recovery and discharge
1 to 3 days- Walking and drinking the same evening
- Diet advanced as the bowel recovers
- Stool softeners started early and continued long term — straining risks the repair
- Discharge on day one to three with written instructions
- Pelvic floor physiotherapy arranged for after healing, particularly where there is incontinence
How to prepare
- If you have been treated for piles for years without improvement, ask specifically for rectal prolapse to be excluded
- Ask to be examined while straining — the prolapse often does not show lying down
- Have the colonoscopy done beforehand; the colon must be checked before any repair
- Treat constipation properly before surgery and be prepared to continue softeners permanently
- Report incontinence honestly, however embarrassing — it changes the assessment and the expectations
- Complete blood tests, ECG and cardiac assessment, particularly if you are older
- Stop smoking, which impairs healing and raises chest complications
- Arrange help at home for the first one to two weeks
- Ask what mesh will be used and why, if mesh is planned
Why patients choose this procedure
The prolapse is corrected
Success rates of 85 to 95% mean the daily routine of pushing something back after every bowel movement simply ends.
Incontinence improves in most patients
Around two-thirds see meaningful improvement as the constant stretching of the sphincter stops and tone recovers over months.
Mucus discharge and bleeding stop
The exposed rectal lining is returned inside, ending the staining, soreness and skin irritation.
Constipation often improves too
Ventral mesh rectopexy specifically avoids the nerve dissection that older techniques required, so obstructed defaecation frequently improves rather than worsens.
Keyhole surgery
Small incisions, less pain, a shorter stay and a return to routine in two to four weeks — even in older patients.
Dignity restored
This is a condition people conceal for years and rarely discuss even with family. The change in confidence and willingness to leave the house is consistently what patients mention first.
Possible risks and side effects
Recurrence
Around 3 to 8% after laparoscopic rectopexy and 15 to 30% after perineal procedures. Continued straining from untreated constipation is the main avoidable contributor, which is why bowel regulation afterwards is permanent rather than temporary.
Persistent incontinence
Correcting the prolapse does not repair a sphincter already damaged by years of stretching or old obstetric injury. Around a third of patients have some ongoing leakage. Improvement continues for six to twelve months, and pelvic floor physiotherapy meaningfully helps.
New or worsened constipation
A recognised problem after posterior rectopexy because of nerve disturbance during dissection. The ventral mesh technique was developed specifically to avoid it, and largely does.
Mesh-related complications
Erosion into the rectum or vagina, infection, or chronic pain. Uncommon, but serious when it occurs and sometimes needing mesh removal. It is entirely reasonable to ask which mesh is being used, why, and what the surgeon's own experience of complications has been.
Injury to bowel, bladder, ureter or nerves
Uncommon, and more likely where previous pelvic surgery has created adhesions and distorted the anatomy.
Sexual dysfunction
Nerves controlling sexual function run close to the rectum. Injury is uncommon with the ventral approach, which is one of the reasons that technique is preferred.
Anastomotic leak after resection
Where bowel is removed and rejoined, the join can leak — a serious complication needing further surgery. It is specific to resection and perineal rectosigmoidectomy rather than to simple rectopexy.
General surgical and anaesthetic risks
Bleeding, infection, clots and chest complications, relevant particularly because many patients are older with other medical conditions. Careful pre-operative optimisation is what reduces them.
What recovery looks like
Recovery after laparoscopic rectopexy is quicker than most patients expect, but it comes with one instruction that lasts for life rather than for weeks: never strain again. The repair holds the rectum in place; straining is what pulled it out in the first place, and it is the main avoidable cause of recurrence.
Days 0 to 2: you sit up and walk the same evening. Expect abdominal soreness and shoulder-tip discomfort from the carbon dioxide, which settles within a day or two and clears faster if you walk. Fluids and then diet as the bowel recovers. Most patients go home on day one to three.
Week 1: soreness settles steadily. Walk daily and increase gradually. Stool softeners are started immediately and are not optional — the first bowel movement should be soft and effortless. Do not strain, do not sit on the toilet for long periods, and do not lift anything heavy.
Weeks 2 to 4: most patients with desk jobs return between the second and fourth week. Driving once you can brake sharply without hesitating. Continue softeners and adequate fibre and fluid. Any bleeding or mucus should have stopped by now — report it if it has not.
Weeks 4 to 8: normal activity resumes. Avoid heavy lifting for at least six weeks. Pelvic floor physiotherapy usually starts around this point, particularly where incontinence was a symptom.
Months 3 to 12: continence continues improving for six to twelve months as the stretched sphincter recovers tone — so judge the result at a year, not at three months. Bowel habit settles into its new normal.
Long term: keep stools soft permanently. Treat constipation promptly, do not strain, and do not linger on the toilet. Report any recurrence of a lump, mucus or bleeding early rather than waiting, because an early recurrence is easier to address.
Contact your care coordinator immediately for severe or worsening abdominal pain, fever, no bowel movement with vomiting and abdominal swelling, heavy rectal bleeding, or discharge from any wound.
What to eat and what to avoid
Recommended
- High-fibre foods — oats, whole grains, dals, fruit and vegetables — to keep stools soft and end straining
- Isabgol or psyllium husk daily, which is inexpensive and highly effective
- 2 to 3 litres of water daily; fibre without fluid makes constipation worse rather than better
- Protein at every meal for wound healing
- Curd and probiotics, particularly while on antibiotics
- Prunes, papaya and figs as natural stool softeners
- Regular walking, which is genuinely one of the best treatments for constipation
Best avoided
- Straining at stool — permanently, this is the single most important restriction
- Sitting on the toilet for long periods, including with a phone
- A low-fibre diet of maida, refined food and fried items
- Inadequate fluid intake, which defeats the purpose of fibre
- Regular use of stimulant laxatives without medical advice, which weakens the bowel over time
- Heavy lifting for at least six weeks after surgery, and heavy straining lifts permanently
- Ignoring the urge to pass stool, which leads to harder stool and more straining
Post-operative care, at no extra cost
- Diet and lifestyle consultation with a nutritionist
- Scheduled follow-up calls until you are fully recovered
- Free cab for the follow-up visit
- 24×7 access to your care coordinator for any concern
Rectal Prolapse treatment cost
₹90,000 – ₹2,50,000
The range depends on the approach — laparoscopic or robotic rectopexy versus a perineal procedure — whether mesh is used and which type, whether other pelvic floor repairs are done at the same time, your city and the hospital. Laparoscopic rectopexy costs more than a perineal repair but has a substantially lower recurrence rate, which usually makes it the better value over time. Rectal prolapse surgery is covered by most health insurance policies once the diagnosis is documented. Our insurance desk verifies eligibility before admission.
Inside the care journey
Rectal Prolapse — your questions answered
Look at what comes out. Prolapsed piles appear as separate purple or dark lobes with grooves running outwards between them, like segments. A rectal prolapse is a single continuous red tube with concentric circular rings around it, like the rings on a tree stump. This distinction is visible to anyone examining you properly — and it matters enormously, because creams, suppositories and haemorrhoid procedures will never treat a prolapse. If you have been treated for piles for years without improvement, ask specifically for this to be excluded.