Full-thickness rectal prolapse is a painful and debilitating condition that often responds well to surgical intervention. The best method of surgical repair is a matter of debate. Historically, perineal approaches have been thought to have inferior outcomes and were therefore reserved for elderly and unfit patients. Despite recent data calling that into question, perineal approaches are still commonly performed and have their role. We present risks and benefits along with a description of perineal approaches for surgical treatment of rectal prolapse.