The term “rectal procidentia” implies circumferential full-thickness descent of the rectum through the anal sphincter. This condition occurs because of several structural and anatomic changes and offers a challenge in its management. There are over 50 different surgical procedures described to correct this condition. Unfortunately, when it occurs in the elderly and infirm, there is very little that can be done. Such poor-risk patients should be managed with a perineal repair as described by Altemeier. The purpose of this article is to review our results and experiences with Altemeier's procedure in managing rectal procidentia in elderly and debilitated patients.