Rectal Prolapse

What is rectal prolapse?

Rectal prolapse is a pelvic floor condition where the rectum, which is the final section of the large intestine, loses its normal attachments inside the body, allowing it to telescope out through the anus. It is often associated with weakness of the anal sphincter muscles, leading to fecal incontinence. Rectal prolapse is more common in women than in men, especially in older age.

There are different types of rectal prolapse:

• Full-thickness rectal prolapse (Procidentia): The entire wall of the rectum protrudes outside the anus.
• Mucosal prolapse: Only the inner lining (mucosa) of the rectum protrudes from the anus. This is more common in children.
• Internal prolapse (intussusception): The rectum folds on itself but does not protrude outside the anus. This can be a cause of obstructive defecation symptoms.

Common Symptoms

Patients with rectal prolapse may experience a range of symptoms, including:

• A reddish-colored mass protruding from the anal opening, which may be more noticeable after a bowel movement.
• Fecal incontinence: Difficulty controlling gas or stool is a very common symptom, reported by 50–75% of patients.
• Feeling of a bulge or fullness in the anal area.
• Straining or incomplete evacuation: A sensation that you cannot empty your bowels completely.
• Bleeding and mucous discharge: The prolapsed tissue can become irritated and may bleed or secrete mucus.
• Pelvic pressure or discomfort.
• Constipation: Many patients also report long-standing constipation.

What causes rectal prolapse?

The exact cause of rectal prolapse is not fully understood, but it is thought to be due to a combination of factors that weaken the muscles and ligaments of the pelvic floor that support the rectum. These factors may include:

• Chronic straining: Long-term straining during bowel movements due to constipation is a major risk factor.
• Childbirth: The process of childbirth can damage the nerves and muscles of the pelvic floor.
• Aging: Pelvic floor muscles and ligaments naturally weaken with age.
• Neurological conditions: Damage to nerves that control the rectum and anal sphincters, such as from spinal cord injuries or diseases, can contribute to prolapse.
• Previous pelvic surgery.
• Anatomical factors: Some individuals may have a naturally redundant (long) colon or a deep pouch of Douglas (the space between the rectum and uterus or bladder).

How is rectal prolapse diagnosed?

Rectal prolapse is most often diagnosed during a physical examination.

• Physical Exam: The doctor will inspect the anal area. To see the full extent of the prolapse, you may be asked to sit on a toilet and strain as if you are having a bowel movement. This allows the doctor to confirm that the full thickness of the rectal wall is protruding.
• Anal Manometry: This test measures the strength of your anal sphincter muscles.
• Defecography: This is a special X-ray or MRI study that shows how well your rectum works during a bowel movement. It can help identify internal prolapse and other associated pelvic floor problems like a rectocele or enterocele.
• Colonoscopy: A colonoscopy may be performed to rule out any other conditions within the colon.

How is rectal prolapse treated?

Treatment for rectal prolapse almost always involves surgery. The goal of surgery is to repair the prolapse, restore normal bowel function, and correct any associated fecal incontinence. There are two general approaches to surgery: abdominal and perineal.

Abdominal Procedures:
These procedures are performed through the abdomen, either with an open incision or, more commonly, with minimally invasive techniques (laparoscopy or robotic surgery). They generally involve pulling the rectum up and fixing it to the sacrum (a procedure called rectopexy). A portion of the colon may also be removed (resection rectopexy) if the patient has severe constipation. Abdominal procedures have a lower recurrence rate but a slightly higher risk of complications than perineal procedures.

• Ventral Mesh Rectopexy: A popular minimally invasive approach where a piece of mesh is used to lift and secure the front of the rectum to the sacrum. This corrects the prolapse while often improving both incontinence and constipation.

Perineal Procedures:
These procedures are performed through an incision around the anus and are often preferred for older patients with significant medical problems as they can be done with spinal anesthesia. They generally have a faster recovery but a higher recurrence rate.

• Altemeier Procedure (Perineal Rectosigmoidectomy): The prolapsed rectum and a portion of the sigmoid colon are pulled out through the anus, removed, and the remaining colon is sutured to the anal canal.
• Delorme Procedure: The inner lining (mucosa) of the prolapsed rectum is removed, the muscular wall is folded and stitched upon itself to shorten it, and the mucosa is then sewn back together.

Self-Care and Prevention

While you cannot always prevent rectal prolapse, you can reduce your risk and manage symptoms by:

• Avoiding constipation and straining: Eat a high-fiber diet, drink plenty of fluids, and use stool softeners or laxatives as needed to keep bowel movements soft and easy to pass.
• Performing Kegel exercises: These exercises can help strengthen the pelvic floor muscles, which may improve symptoms of mild prolapse or incontinence.
• Maintaining a healthy weight: Excess weight puts more pressure on the pelvic floor.

Is rectal prolapse the same as hemorrhoids?
No, they are different conditions. Hemorrhoids are swollen veins in the anal canal, while rectal prolapse involves the entire rectal wall. Prolapsed hemorrhoids can look similar to a small rectal prolapse, but a key difference is the pattern of the folds in the tissue: rectal prolapse has concentric (circular) folds, whereas hemorrhoids have radial (spoke-like) folds.

Can rectal prolapse be treated without surgery?
In adults, rectal prolapse is an anatomical problem that requires surgical correction. Non-surgical treatments are focused on managing symptoms like constipation but will not fix the underlying prolapse.

Will surgery for rectal prolapse fix my incontinence?
Surgery for rectal prolapse often improves fecal incontinence, but it is not a guarantee. About 50-60% of patients experience significant improvement in their continence after surgery. Sometimes, additional treatments like pelvic floor physical therapy or sacral nerve stimulation may be needed.

• Murphy M, Vogler SA. Rectal Prolapse. In: Steele SR, Hull TL, Hyman N, Maykel JA, Read TE, Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal Surgery. 4th ed. Springer; 2022:1019-1033.
• American Society of Colon and Rectal Surgeons. Rectal Prolapse. Accessed September 28, 2026. https://fascrs.org/Web/Patients/Diseases-and-Conditions/A-Z/Rectal-Prolapse--1-.aspx
• National Institute of Diabetes and Digestive and Kidney Diseases. Rectal Prolapse. Accessed September 28, 2026. https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract/rectal-prolapse