What Is Rectal Prolapse?

Rectal prolapse occurs when the rectum (the lower portion of the large intestine) slides out of place and entirely or partially protrudes outside the anus. This can result in symptoms like pressure in the anal area, leakage of mucus, stool, or blood from the anus, and anal itching or pain.

Many factors can contribute to the development of rectal prolapse, including constipation, chronic coughing, and problems with the muscles or nerves in the pelvic region. Treatment for rectal prolapse may involve surgery, though non-invasive approaches may be enough to heal a mild prolapse.

Rectal prolapse is rare, affecting less than 1% of the general population. People of any age can develop rectal prolapse, though it is most common in older adults, especially people assigned female at birth.

Types

There are three types of rectal prolapse, classified based on which part of the rectum has slipped out of place. 

Partial (Mucosal) Prolapse 

Partial prolapse, or mucosal prolapse, is when the rectum's inner lining (mucous membrane) bulges through the anus.

Complete Prolapse

Complete prolapse is when the entire thickness of the rectal wall sags and slides outside the anus. This may only occur after bowel movements initially; over time, the prolapse may not slide back into position on its own and constantly protrude out of the anus.

Internal prolapse (Intussusception)

Internal prolapse, or rectal intussusception, occurs when a section of the rectum folds into itself, causing it to telescope or slide down into the lower part of the rectum or the anus. This type is usually not visible externally but can still cause typical prolapse symptoms.

Rectal Prolapse Symptoms 

Rectal prolapse generally develops gradually and worsens over time. Initially, you may experience the sensation of incomplete bowel movements. As the condition progresses, you may develop other symptoms, and the rectum can prolapse when standing, walking, or coughing.

Rectal prolapse symptoms can include:

• Reddish-colored tissue protruding from the anus 
• Anal pain or discomfort 
• Leakage of mucus, stool, or blood from the anus 
• Changes to bowel habits, such as more frequent bowel movements and smaller tools 
• Constipation (difficulty having a bowel movement)
• Diarrhea (frequent loose stools)

What Causes Rectal Prolapse? 

Rectal prolapse occurs when the tissues supporting the rectum weaken or deteriorate, causing it to shift from its normal position and protrude from the anus. The exact cause is unknown, but structural problems with nerves or muscles in the pelvic region and lower gastrointestinal (GI) tract likely play a role.

Adults with rectal prolapses often have weak pelvic floor muscles and anal sphincters. Whether these structural problems cause rectal prolapse or if rectal prolapse triggers or worsens these issues is unclear.

Infants and young children who experience rectal prolapse often have differences in the structure of their rectums. Normally, the rectum has a slight curve, but many children with rectal prolapse have straight rectums.

Risk Factors

Certain factors can increase your risk of developing rectal prolapse, including:

• Sex: People assigned female at birth are six times more likely to develop rectal prolapse than those assigned male at birth.
• Age: Rectal prolapse is most common in adults ages 50 and older. 
• Neuromuscular disorders: Conditions that affect the muscles or nerves are linked to an increased risk of rectal prolapses, such as spinal/back injuries and multiple sclerosis.
  

Conditions that weaken pelvic floor muscles or increase pressure inside the abdomen are associated with an increased risk of rectal prolapse, including:

• Chronic constipation 
• Straining during bowel movements
• Cystic fibrosis 
• Chronic diarrhea 
• Persistent coughing or sneezing (e.g., whooping cough) 
• Parasitic infections 

Diagnosis

To diagnose rectal prolapse, your healthcare provider will review your medical history, ask about your symptoms, and examine your rectum to check for a prolapse. If your provider cannot see a prolapse, they may perform a digital rectal exam or ask you to bear down as if you are having a bowel movement. They may refer you to a gastroenterologist, a doctor specializing in gastrointestinal disorders.

To confirm the diagnosis, your healthcare provider may order diagnostic tests, including: 

• Anorectal manometry: A small probe inserted into the anus measures the pressures of the anal sphincter and rectal muscles and evaluates their function. 
• Defecography: You are given an enema for this test to stimulate a bowel movement. X-ray or magnetic resonance imaging (MRI) may be performed as you sit on a specialized toilet and bear down to remove the enema fluid from your body. The images help healthcare providers evaluate the structure, movement, and function of your muscles and organs during a bowel movement. 
• Colonoscopy: A flexible tube with a camera is inserted into the anus to help visualize the rectal lining and colon. This test helps rule out other possible causes of your symptoms and confirm a rectal prolapse diagnosis. 

Treatments for Rectal Prolapse  

Treatment for rectal prolapse depends on the type of prolapse and the severity of your symptoms.

Non-invasive approaches that help prevent strain during bowel movements may sufficiently improve or reverse a partial prolapse. This may include eating a high-fiber diet, taking fiber supplements to help stool pass easily, and/or drinking 8-10 glasses of water daily to stay hydrated and promote smooth bowel movements.

Most of the time, surgery is the only option to restore the rectum to its proper position and provide lasting relief from symptoms. Rectal prolapse repair is performed in one of two ways: abdominal or perineal.

Abdominal Rectal Prolapse Repair 

Abdominal surgical approaches involve surgeons making an incision in the abdominal cavity to pull the rectum into its proper position. Abdominal repair techniques include:

• Rectopexy: This involves pulling the rectum upwards and securing it to the back of the pelvic wall. This procedure is highly effective—90% of people who undergo rectopexy do not experience recurrent (repeat) prolapse.  
• Resection rectopexy: This combines securing the rectum in its proper position with bowel resection, which involves removing a portion of the colon to improve bowel function. People with chronic constipation may require this procedure. 
  

Perineal Rectal Prolapse Repair 

Perineal surgical approaches involve repairing rectal prolapse through the perineum, which is the area between the anus and genitals. Perineal repair is usually less complex and has shorter recovery times, though it has higher rates of recurrent (repeat) rectal prolapses. This approach is typically reserved for older adults, those with serious medical conditions, and in cases of emergency when the rectum is cut off from its blood supply and requires immediate treatment. 

Perineal repair techniques include:

• Altemeier procedure: Involves removing the prolapsed rectum from the body and securing the remaining colon to the anus.
• Delorme procedure: Involves removing the inner lining of the rectum and folding and stitching the rectal muscles to reduce the prolapse. 
  

Prevention

You can lower your risk of rectal prolapse by making dietary choices that support your digestive health. Here are some tips:

• Stay hydrated: Drinking water throughout the day can help keep stools soft and prevent constipation.
• Eat a fiber-rich diet: Foods high in fiber, like leafy green vegetables, beans and legumes, and fruit, help promote smooth bowel movements and reduce constipation. 
• Avoid straining: Straining during bowel movements increases the risk of rectal prolapse. Evidence suggests having your knees higher than your hips while sitting on the toilet may reduce straining. You can use a footstool to elevate your knees comfortably.
• Pelvic floor exercises: Exercises designed to strengthen the pelvic muscles (e.g., Kegels) may help lower your risk of rectal prolapse.

Complications 

Rectal prolapse is associated with several complications, including:

• Fecal incontinence: Weakened or damaged rectal muscles or nerves can result in difficulty controlling bowel movements, causing involuntary leakage of stool.
• Rectal ulcers: Protruding rectal tissue can become damaged, forming ulcers that cause pain and bleeding.
• Strangulation: The prolapsed tissue may become trapped outside the body, potentially cutting off its blood supply and causing tissue death.

A Quick Review

Rectal prolapse is when the rectum protrudes from the anus, causing symptoms such as constipation, changes to bowel movements, and leakage of stool, mucus, or blood from the anus. Many factors can lead to rectal prolapse, including weakened pelvic muscles and chronic constipation or straining during bowel movements. 

Treatment options vary, depending on the severity of your symptoms. Sometimes lifestyle adjustments, such as eating a fiber-rich diet and drinking plenty of fluids, are enough to heal a partial prolapse. Surgery is recommended for complete rectal prolapse. See a healthcare provider if you suspect you have rectal prolapse. Early diagnosis and treatment can help relieve symptoms and prevent complications.