Skip to main contentLast updated: 04-Nov-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
GI & Proctology Surgeon
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad · 18 years of experience
In short
Yes, a rectal prolapse can be repaired through the anus, with no cut on the belly. The two common operations are called Delorme and Altemeier.
These operations are gentler on the body. They suit people who are older, frail or unfit for a big operation, and they are the right choice in an emergency.
The trade is that the prolapse comes back more often than after an operation through the belly. This is a fair choice, not a lesser one, when it fits the person.
For the whole picture of prolapse care, read our rectal prolapse surgery page. This post explains the operations done from below, and who they suit.
The surgeon reaches the prolapsed bowel through the anus itself. Nothing is opened on the belly, and no scar shows.
This route is often called perineal repair, after the area between the anus and the genitals. Because the belly is not opened, there is usually less pain, less ileus (a slow, sleepy bowel) and a shorter stay.
It is mostly for people for whom an operation through the belly carries more risk than benefit. It is also the way to deal with a prolapse that is stuck.
| Situation | Usual choice | Why |
|---|---|---|
| Frail or older person with weak heart or lungs | Delorme or Altemeier, often under a spinal | Avoids a general anaesthetic and a belly operation |
| Short prolapse that is mostly the lining | Delorme | A small, gentle operation matches a small problem |
| Long prolapse, or a long loose sigmoid colon | Altemeier | The extra bowel is removed, which lowers the chance of return |
| Prolapse stuck outside, dark or dying | Emergency Altemeier | Dead bowel must be removed, never pushed back inside |
| Many earlier operations on the belly | Either, from below | Avoids scar tissue inside the belly |
| You do not want mesh or a belly operation | Either, from below | No mesh is used |
A fit, younger person with a long life ahead is often better served by a repair through the belly, because it holds for longer. We will say so honestly.
In a Delorme, the inner lining of the prolapsed bowel is stripped off like a sleeve. The muscle underneath is then folded up like a concertina and the lining is sewn back.
The Delorme is quick and can be done under a spinal. It suits a short prolapse and a very frail person. It is not the right fit for a long prolapse, because the problem tends to return.
In an Altemeier, the whole prolapsed length of bowel is cut out through the anus, and the healthy end is joined to the anal canal. A muscle repair is often added at the same time.
| Feature | Delorme | Altemeier |
|---|---|---|
| What is done | Lining stripped, muscle folded | Whole prolapsed bowel cut out and joined to the anus |
| Suited to | Short prolapse, very frail person | Long prolapse, loose sigmoid, stuck or dying bowel |
| A join in the bowel | No | Yes, so a leak or bleed is possible |
| Muscle repair for control | Folds thicken the ring | Often added, and helps control |
| Chance of the prolapse returning | Higher | Lower than Delorme but higher than a belly repair |
| Anaesthetic | Spinal often enough | Spinal or general |
The muscle repair in front of the bowel matters. It brings the pelvic floor muscles together and often improves control of stool, so we do not leave it out when it is safe to add.
A prolapse that cannot be pushed back, and looks dark, swollen or is very painful, needs a doctor the same day.
Recovery from below is usually quicker than from a belly operation. Loose, urgent stools for some weeks are common and usually settle.
| Problem | What it looks like | What we do |
|---|---|---|
| Prolapse returns | The lump comes out again, months or years later | Repeat repair from below, or a belly repair if you are fitter now |
| Bleeding from the stitch line | Fresh blood from the anus in the first two days | A quick check under anaesthetic and extra stitches |
| Leak at the join (Altemeier) | Pain, fever or discharge some days later | Scan, antibiotics, drainage if needed |
| Narrowing of the anus | Hard to pass stool after some weeks | Gentle stretching, rarely a small revision |
| Leaking stool that continues | Soiling even after the prolapse is fixed | Exercises, biofeedback and other options |
Read about complications and follow-up to see how recovery is watched, and about the repair through the abdomen to compare the two routes.
No. For a frail or older person it is often the safer first choice. A large trial found no clear winner between the two routes. The price of the gentler route is that the prolapse comes back more often.
Not always. Many of these operations can be done with a spinal injection, which numbs the lower body while you stay awake or lightly sedated. This is a real advantage if your heart or lungs are weak.
In a Delorme the inner lining is stripped off and the muscle underneath is folded up like a concertina. In an Altemeier the whole prolapsed bowel is cut out and the healthy end is joined to the anus. The Altemeier is used for a longer prolapse.
Do not push hard on it. A bowel that is dark, swollen or very painful needs a doctor the same day. If the bowel has died, the dead part must be removed, and the Altemeier operation is made for this.
Many people leak less once the prolapse is gone. A muscle repair added to the Altemeier often helps control. Some leakage can remain, and we then talk about exercises and other treatment.
Yes, and more often than after an operation through the belly. If it does, a repeat repair from below is possible. A fitter person may later choose a repair through the belly instead.
Most people sit up, eat and walk within a day or two. Stools can be loose and urgent for some weeks. We give you a plan for fibre and stool softeners so you do not strain.
For the full range of prolapse care, start at the rectal prolapse surgery page. For questions before you travel, call +91-63555-64601.
Dr Harsh Shah — Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Consultations, review of reports and scans, operations and follow-up. OPD Monday to Saturday, 9 am to 5 pm.
Appointments: +91-63555-64601 · +91-63590-11009 · Hospital 079-2663 6363
Directions to the hospital · WhatsApp +91-63555-64601
Is the bowel coming out of your anus, and are you older, or unwell enough that a big operation worries you? There is another way to repair it, from below, with no cut on the belly. Dr Harsh Shah will examine you, explain which repair suits your body, and tell you plainly what it can and cannot do. Call, or send a message on WhatsApp. Call +91-63555-64601 Ask on WhatsApp
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