Rectal prolapse awareness

Overview

Rectal prolapse is when part of the rectum, the last part of the large intestine, slips down and sticks out of the anus. It may feel like a lump or bulge, especially during or after a bowel movement.

Rectal prolapse is not very common, but it can occur at any age. It is more frequent in older adults, particularly women.

It most often affects older women, but men and children can also develop rectal prolapse. People with long-term constipation or multiple vaginal deliveries are at higher risk.

Symptoms

Common symptoms

• A feeling of a lump or bulge coming out of the anus, especially during bowel movements.
• Difficulty controlling bowel movements (leakage of stool or mucus).
• Bleeding or mucus from the anus.
• A feeling that you haven't fully emptied your bowels.

Symptoms in children

• A reddish lump that appears at the anus during a bowel movement and usually goes away afterwards.
• Often no pain or discomfort, and it may resolve on its own as the child grows.

Symptoms in older adults

• More frequent or constant feeling of a bulge.
• Leakage of stool or gas (incontinence).
• May be harder to push the prolapse back inside.

Causes

Main causes

• Weakness of the pelvic floor muscles, which support the rectum.
• Chronic constipation and frequent straining during bowel movements.
• Long-term diarrhea or coughing.
• Aging, which can weaken muscles and tissues.

Risk factors

• Being female and having given birth multiple times.
• Being older, especially over 50 years.
• Chronic constipation or straining from heavy lifting.
• Previous pelvic surgery or conditions that increase abdominal pressure.

When to see a doctor

See a doctor urgently if:

• If you have a prolapse that will not go back in, is very painful, or is changing colour.
• If you have severe bleeding or signs of a blocked bowel.

Book a routine appointment if:

• Any lump or bulge from your anus, even if it goes back on its own.
• Leakage of stool or mucus that bothers you.
• A feeling of incomplete emptying after bowel movements.

Diagnosis

Your doctor can usually diagnose rectal prolapse with a physical exam, often asking you to squat or bear down like you are having a bowel movement to make the prolapse visible.

Tests that may be done

• Digital rectal exam – a gloved finger inserted to assess muscles and check for other problems.
• Colonoscopy – a camera test to look inside the colon and rule out other causes.
• Defecography – an X-ray or MRI while you pass stool to see how the rectum and muscles work.

What to expect at your appointment

Your doctor will ask about your symptoms, bowel habits, and medical history. The examination may feel a little uncomfortable but is usually quick and painless.

Treatment

Treatment depends on how severe the prolapse is. Mild cases can often be managed with lifestyle changes and non-surgical treatments. More serious or persistent prolapses may require surgery.

Self-care at home

• Avoid straining during bowel movements by using a footstool to bring your knees above your hips.
• Do pelvic floor exercises (Kegels) daily to strengthen the muscles that support the rectum.
• If the prolapse comes out, gently push it back inside using a clean, lubricated finger (your doctor can show you how).

Medical treatments

Your doctor may recommend stool softeners or fiber supplements to prevent constipation. Pelvic floor physiotherapy or biofeedback can help retrain muscles. In some cases, a small rubber band or other device may be used to support the rectum.

When is surgery considered?

If non-surgical treatments do not improve the prolapse, or if the prolapse is severe, surgery may be recommended to repair the weakened muscles and support the rectum. This surgery is usually successful.

Living with this condition

Living with rectal prolapse can be managed with good bowel habits and regular self-care. Use soft, moist wipes instead of dry toilet paper, and wear a pad if you have leakage.

Lifestyle tips

• Avoid heavy lifting and activities that put a lot of strain on your abdomen.
• Maintain a healthy weight to reduce pressure on the pelvic floor.
• Stay active with gentle exercises like walking or swimming.

Diet and exercise

Eat a high-fiber diet with plenty of fruits, vegetables, and whole grains. Drink eight or more glasses of water each day. Regular exercise helps prevent constipation and strengthens the body.

Mental health and emotional wellbeing

Rectal prolapse can feel embarrassing or upsetting, but it is a medical condition, not your fault. It can affect your confidence and daily life. Remember that treatment is available, and talking to your doctor or a counselor can help.

Prevention

In many cases, yes. You can reduce your risk by avoiding constipation and straining, strengthening your pelvic floor muscles with exercises, and treating problems like chronic cough or heavy lifting.

Complications

If left untreated

• Skin irritation, sores, or ulcers around the anus.
• Difficulty controlling bowel movements (incontinence).
• In rare cases, the prolapse can get stuck (strangulated), cutting off blood supply and requiring emergency treatment.

Long-term outlook

With proper care and treatment, most people with rectal prolapse feel much better. Non-surgical treatments often work well, and surgery is very successful if needed. Early treatment helps prevent complications and improve quality of life.

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