Rectal prolapse occurs when part of the large intestine, or rectum, protrudes from the anus. The rectum is the last part of the large intestine and is where the body stores feces before voiding.

Rectal prolapse happens when the rectum becomes unattached inside the body and comes out through the anus, effectively turning itself inside out. This condition is typically due to a weakening of the muscles that support the rectum.

Rectal prolapse is a relatively rare condition, with the American Society of Colon & Rectal Surgeons estimating that it affects fewer than 3 in every 100,000 people.

Although the condition can affect anyone, it is more common in older females. Other risk factors include chronic constipation, straining, and childbirth. Rectal prolapse can cause difficulty controlling bowel movements, and it can lead to incontinence. Early treatment may involve fluids, an increased fiber intake, and pelvic floor exercises, but most people will eventually require surgery.

An image of pipes to represent the intestines, which protrude out the anus during a rectal prolapse.Share on Pinterest
Raymond Forbes Photography/Stocksy

There are three types of rectal prolapse:

  • External: Also known as full-thickness or complete prolapse, the entire thickness of the wall of the rectum sticks out through the anus.
  • Mucosal: Only the lining of the anus, known as the mucosa, sticks out through the anus.
  • Internal: Also known as an incomplete prolapse, the rectum folds in on itself but does not stick out through the anus.

At first, the person might only notice a lump or swelling coming out of their anus when they have a bowel movement. Initially, the person may be able to push the rectal prolapse back in, or it might naturally return inside the anus. Over time, however, the prolapse is likely to protrude permanently, and a person will be unable to push it back.

As time goes on, a rectal prolapse may happen when a person coughs, sneezes, stands up, or exercises. Some people with a rectal prolapse may describe the sensation as being similar to sitting on a ball.

Some people may experience an internal rectal prolapse, which is different in that the prolapse will not protrude. However, the person may experience the feeling of an incomplete bowel movement or pressure in the rectum.

Other symptoms of a rectal prolapse can include:

  • difficulty controlling bowel movements, which occurs in about 50–75% of cases
  • constipation, which affects about 25–50% of people who have a rectal prolapse
  • bright red blood coming out of the rectum
  • rectal pressure and discomfort
  • mucous discharge

Complications may include:

  • Strangulated prolapse: This occurs when part of the rectum becomes trapped and cuts off the blood supply, causing tissue to die. The individual may develop gangrene, causing this section of the rectum to die and decay. This is often painful and requires surgery.
  • Solitary rectal ulcer syndrome: Present in mucosal prolapse, ulcers can develop on the part of the rectum sticking out. This complication often requires surgery.
  • Recurring prolapse: People who have surgery for a rectal prolapse may have another prolapse in the future. Evidence suggests that this occurs in up to 30% of cases. As a result, doctors may advise a person to make lifestyle adjustments after surgery, such as adopting a high fiber diet and taking a proactive approach to hydration.

Rectal prolapse has multiple associated risk factors and causes, although doctors do not fully understand why some people get it.

It often involves a weakening of the muscles that support the rectum and has various possible triggers, including:

  • pregnancy
  • constipation or chronic straining
  • diarrhea, which affects about 15% of people
  • conditions that affect the pelvis or lower gastrointestinal tract

Some neurological conditions also affect the nerves associated with rectal prolapse:

Rectal prolapse is more common in adults than children, and it is particularly prevalent in females aged 50 years or older, who are six times as likely to be affected as males. Most females who have rectal prolapse are in their 60s, while most males are aged 40 years or younger.

In the case of older females, rectal prolapse will often occur at the same time as a prolapsed bladder or gynecologic organ. This combined prolapse may occur due to general weakness in the pelvic floor muscles.

People may confuse rectal prolapse with hemorrhoids, which are also known as piles. Both conditions affect the last section of the bowel and have similar symptoms.

However, while rectal prolapse affects the rectal wall, hemorrhoids affect the blood vessels in the anal canal. These two conditions require different treatment, so it is important to get the correct diagnosis.

To diagnose a rectal prolapse, the doctor will look at the person’s medical history, ask them about their symptoms, and conduct a physical examination.

The physical examination may involve the doctor inserting a lubricated, gloved finger into the rectum or observing a person’s anus while they are squatting as though they are on a toilet or commode. Although some people may find this uncomfortable and possibly embarrassing, it should not be painful and is very important for an accurate diagnosis.

Further tests may be necessary to clarify the diagnosis or rule out other processes. These tests can include:

  • Defecography: Also known as a proctography, this is a type of X-ray that shows the rectum and anal canal during a bowel movement.
  • Colonoscopy: During this procedure, the doctor inserts a long, flexible, tube-like camera called a colonoscope to take a closer look at the large intestine and rectum.
  • Anorectal manometry: This involves placing a pressure-measuring tube inside the rectum to check how well the muscles that control bowel movements are working.
  • Endoanal ultrasound: Using a thin ultrasound probe, the doctor will look at the muscles that the body uses to control the bowels

Although a rectal prolapse is not often an emergency medical problem, it can be uncomfortable, cause embarrassment, and have a significant adverse effect on the person’s mental and physical well-being.

Therefore, it is essential for anyone who has noticed any signs or symptoms of rectal prolapse to speak with a doctor as soon as possible.

The longer a person puts off receiving treatment for rectal prolapse, the higher the chance of permanent problems, such as incontinence and nerve damage.

In the first instance, it is important to relieve the symptoms and allow easier bowel movements. Doctors may recommend a high fiber diet, stool softeners, and bowel training, as well as drinking plenty of water.

If that does not work, then a doctor will suggest a surgical option. The type of surgery will depend on several factors:

  • type of prolapse
  • the person’s age
  • other medical problems
  • whether the person has constipation

There are two general types of surgery for rectal prolapse:

Abdominal

This method involves making an incision in the belly, or lower abdomen. The surgeon then pulls the rectum upward and attaches it to other structures in the body to hold it in the appropriate position.

Perineal

This approach does not involve an abdominal incision. Instead, a surgeon cuts the protruding rectum and attaches the remaining rectum to the anus.

People can take certain steps to lower their risk of rectal prolapse. These include:

  • eating plenty of fiber
  • drinking plenty of water
  • exercising regularly
  • avoiding excessive straining during a bowel movement

Most people make a full recovery after treatment for rectal prolapse. However, proper recovery is crucial, and how long this takes will depend on the type of treatment.

Typically, people who have had surgery spend a few days in the hospital after the operation, and most make a complete recovery within a few months. After undergoing surgery for a rectal prolapse, people should try to avoid straining and heavy lifting for at least 6 months, consume a nutritious and high fiber diet, and drink plenty of water.