The simultaneous occurrence of uterovaginal and rectal prolapse, i.e. dual prolapse, is uncommon. However, these two conditions can be managed concurrently through a combination of perineal, abdominal and laparoscopic approaches. In this article, we present a series of four cases wherein a perineal approach was utilized successfully.

All 4 patients had varying degrees of uterine prolapse, cystocele and rectocele along with external rectal prolapse. They all had completed their families and provided consent for hysterectomy. One patient underwent vaginal hysterectomy and pelvic floor repair along with the Delorme procedure for rectal prolapse, while the remaining three patients had vaginal hysterectomy and anterior colporrhaphy and posterior colpoperineorrhaphy with levatorplasty.

Follow-up evaluation 6 months after surgery revealed complete resolution of symptoms with no vault prolapse and rectal prolapse on examination. It is worth noting that all surgeries were performed under spinal anaesthesia, making this approach suitable for candidates who are at high risk during general anaesthesia, thereby allowing for simultaneous treatment of uterovaginal and rectal prolapse via perineal repair techniques. Also, assistance from surgeons was taken only in one case where Delorme procedure was performed, and in rest 3 cases, satisfactory surgical outcomes were seen following a good posterior colpoperineorrhaphy.

Concomitant repair of both uterovaginal and rectal prolapse can be successfully performed by combining vaginal hysterectomy along with a good posterior colpoperineorrhaphy or Delorme procedure under spinal anaesthesia.