14615 Rectal Prolapse

Overview

Rectal prolapse is when the rectum — the last part of the large intestine — slips down and may stick out through the anus. It can be internal (parts of the rectum move but stay inside) or external (the tissue is visible outside the body). This can cause discomfort, a feeling of something coming out, and sometimes problems with bowel control.

Rectal prolapse is not extremely common, but it is a known condition that many doctors see in practice. It affects a small number of people each year, and it is more likely if you have certain risk factors like long-term constipation or a previous pelvic surgery.

Rectal prolapse can affect anyone, but it happens most often in two groups: older adults (especially women) and young children under age 3. It is also more likely in women who have given birth, people with chronic constipation, and those who have had pelvic surgery.

Symptoms

Common symptoms

• A feeling that something is bulging or sticking out of the anus
• Visible pink or red tissue protruding from the anus, especially after a bowel movement
• Mucus discharge from the anus
• Light bleeding or staining on toilet paper
• Trouble controlling gas or stool (incontinence)
• Feeling like the bowel does not fully empty
• Pain, pressure, or aching around the anus

Symptoms in children

• Visible red or pink tissue coming out of the anus during a bowel movement
• The tissue usually goes back in on its own or can be gently pushed back
• Small amount of mucus or streaks of blood
• Children rarely have pain, but they may be upset or frightened by the bulge

Symptoms in older adults

• Similar symptoms as in adults, but often more noticeable
• A constant feeling of fullness or pressure in the rectum
• The prolapse may not go back in by itself and can require manual repositioning
• More difficulty holding in gas or stool, which can leak without warning
• Discomfort when sitting or walking

Causes

Main causes

• Weakness in the muscles and ligaments that normally keep the rectum in place
• Long-term straining during bowel movements, often due to chronic constipation
• Pregnancy and vaginal childbirth, which can stretch and weaken pelvic floor muscles
• Heavy lifting or any activity that puts repeated pressure on the pelvic area
• Conditions that increase pressure in the belly, such as a long-lasting cough

Risk factors

• Being over 50, especially being an older woman
• Long-term constipation or regularly needing to strain
• Previous pelvic surgery or childbirth injury
• Obesity
• Chronic cough from lung conditions like COPD or smoking
• Nerve damage from spinal cord issues or previous pelvic cancer treatment
• A family history of pelvic floor problems

When to see a doctor

See a doctor urgently if:

• You have a rectal prolapse that becomes red, swollen, very painful, or turns dark in color
• You notice heavy bleeding or cannot empty your bowels
• You develop fever, chills, or severe abdominal pain
• You cannot push the prolapse back after trying gently

Book a routine appointment if:

• You notice a bulge or protrusion from your anus, even if it goes back by itself
• You have a feeling that something is falling down inside your bottom
• You have mucus, bleeding, or leakage that worries you
• You have difficulty controlling gas or stool

Diagnosis

Your doctor will first ask about your symptoms, your medical history, and any straining or pressure problems you have. Then they will examine your bottom, usually while you are lying on your side or sitting on a special toilet. They may ask you to strain or push, to see whether the prolapse appears. In some cases, you may be referred to a specialist for further tests.

Tests that may be done

• Physical examination — the doctor looks and feels the area, and may ask you to push down
• Anorectal manometry — a small tube measures the strength of your sphincter muscles
• Defecography — a special x-ray taken while you have a bowel movement to see how the rectum moves
• Ultrasound or MRI — to look more closely at the pelvic floor muscles and organs
• Colonoscopy — a thin tube with a camera may be used to check the inside of the bowel, especially if there is bleeding

What to expect at your appointment

The examination may feel awkward, but it is quick and done in a private room. Your doctor will be gentle and talk you through each step. You may be asked to change into a gown and lie down. If you need a test like defecography, you will use a private toilet with special equipment. These tests do not hurt, and you can go home the same day.

Treatment

Treatment for rectal prolapse depends on how severe it is, how much it affects your daily life, and your overall health. For mild cases, simple self-care and pelvic floor training may be enough. For more severe or ongoing prolapse, surgery is often the most successful option.

Self-care at home

• Try not to strain when going to the toilet — sit comfortably and give yourself enough time
• Eat a high-fiber diet with plenty of fruits, vegetables, and whole grains to keep stools soft
• Drink enough water throughout the day (about 6–8 glasses) unless your doctor says otherwise
• Do pelvic floor (Kegel) exercises regularly to strengthen the muscles around the rectum
• If your doctor teaches you how, you can gently push the prolapse back in with a soft cloth or wet finger after a bowel movement
• Avoid heavy lifting and long periods of sitting on the toilet

Medical treatments

Your doctor may suggest medicines to soften your stool or to treat constipation, but only after checking what is safe for you. For some people, a supportive device called a pessary or a small anal plug can help hold the rectum in place. In certain cases, especially in women, creams or gels that contain hormones may be prescribed to help strengthen the tissues — these are only used under medical guidance and with a prescription. Always discuss any product with your doctor or pharmacist before using it.

When is surgery considered?

Surgery is usually recommended when the prolapse is severe, causes pain, or does not improve with self-care. There are several types of surgery — some are done through the abdomen (belly), and some through the area between the anus and genitals (perineum). The right option depends on your age, your overall health, and the type of prolapse you have. Your surgeon will explain the risks and benefits so that you can make an informed decision.

Living with this condition

Living with rectal prolapse can feel stressful, but there are practical ways to manage it. You may need to set a regular time each day for a bowel movement, keep your bottom clean, and gently push the prolapse back if your doctor has shown you how. Doing pelvic floor exercises daily can make a real difference over time.

Lifestyle tips

• Eat a balanced diet with enough fiber to prevent constipation
• Stay active with gentle exercise like walking or swimming
• Keep a healthy weight to reduce pressure on your pelvic floor
• Avoid heavy lifting, or use proper techniques when you must lift something
• Don't sit on the toilet for more than a few minutes at a time
• Take breaks during the day to relax your pelvic muscles

Diet and exercise

A high-fiber diet is key — think whole grains, beans, fruits, and vegetables. Drink plenty of water to help the fiber work. Regular exercise keeps your bowels moving and helps you manage weight, but avoid exercises that involve heavy straining or holding your breath. Your doctor or a physiotherapist can teach you specific pelvic floor exercises, sometimes called Kegel exercises, which are a safe and effective way to strengthen the area.

Mental health and emotional wellbeing

It is normal to feel embarrassed, anxious, or even depressed about rectal prolapse. You might worry about odor, leakage, or sex. Please know that these feelings are common and you are not alone. Talking to your doctor about your concerns is the first step. Some people find it helpful to speak with a counselor or therapist, especially if the condition is affecting their mood or relationships.

Prevention

You cannot always prevent rectal prolapse, but you can lower your risk by taking care of your pelvic floor. This includes treating constipation early, avoiding long-term straining, doing pelvic floor exercises, and managing any long-lasting cough. If you have already had a prolapse, these steps can also help stop it from coming back.

Vaccines

There is no vaccine for rectal prolapse.

Screening programmes

There is no routine screening test for rectal prolapse. However, if you have risk factors like long-term constipation or a family history of pelvic floor problems, your doctor may keep a closer eye on your symptoms during regular check-ups.

Complications

If left untreated

• The prolapse may become more frequent and harder to push back in
• The protruding tissue can become ulcerated or develop sores
• The tissue can become trapped (incarcerated) or strangulated, meaning the blood supply is cut off — this is a surgical emergency
• You may develop a bowel obstruction, which causes severe belly pain and vomiting
• Long-term loss of bowel control can become permanent
• Pelvic floor muscles and nerves can become weaker over time

Long-term outlook

The outlook for rectal prolapse is generally very good. Many people improve with simple measures like dietary changes and pelvic floor exercises. For those who need surgery, the success rate is high and most people get long-lasting relief. Even if the prolapse comes back, there are further treatment options. With the right support from your healthcare team, you can manage the condition and get back to your normal life.

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