Full thickness prolapse of rectum through anus

• Weakness of levator ani
• Starts at weak anterior wall
• Protrudes 10-15cm in lenght
• Contains pouch of peritoneum anteriorly (which can sometimes contain small intestine)

1. Perineal approach
   • Delorme's operation - rectal mucosa removed circumferentially from prolapsed rectum; sutured in "concertina" fashion to reduce prolapse and create ring of muscle within anal canal - narrows orifice and prevents recurrence
2. Abdominal approach
   • Wells operation - rectum fixed firmly to sacrum by inserting sheet of polypropelene mesh between them
   • Suture rectopexy - 4-6 interrupted sutures used to fix rectum to sacrum

1. Digital repositioning
2. Phenol submucous injections
3. Excision of prolapsed mucosa

1. Laxatives / stool bulking agents
2. Dietary modifications