Rectal Prolapse: What It Is and How Doctors Treat It

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
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Rectal prolapse occurs when the rectum slips through the anus. Common causes include a weak pelvic floor, chronic constipation, and spinal cord problems. According to the National Institute of Diabetes and Digestive and Kidney Diseases, people assigned female at birth account for roughly 80–90% of adult occurrences of rectal prolapse.

Read on to learn more about rectal prolapse, including what causes it and how to treat it.

What is rectal prolapse? 

The shadow of a hand on a female's back side
Alexey Kuzma/Stocksy United

Rectal prolapse happens when the rectum slides down through the anus. It typically occurs when the muscles that support the rectum become weak.

Most cases of rectal prolapse are mild and require minimal intervention. However, some cases are serious and require prompt and effective treatment.

One Finnish study indicates that complete rectal prolapse affects approximately 2.5 out of 100,000 people every year.

Types of rectal prolapse 

Rectal prolapse usually presents in one of three ways.

  • Complete prolapse: This is when the whole thickness of the rectal wall drops down the anus.
  • Partial prolapse: This is when only the lining of the anus sticks out through the anus.
  • Internal prolapse: This is when the lining of the rectum folds in on itself but does not stick out through the anus.

Rectal prolapse vs. hemorrhoids

Rectal prolapse and hemorrhoids share some similarities. However, they are different conditions. 

Hemorrhoids occur when the veins in the anus and lower rectum become swollen. They can cause itching, discomfort, and inflammation. Bleeding and severe pain might also occur.

However, hemorrhoids do not make the rectum drop down as rectal prolapse does.

Read about 10 common digestive disorders.

What are the symptoms of rectal prolapse?

In many cases, rectal prolapse generally presents as a reddish mass sticking out of the anus. The mass may retreat on its own after a while or when you push it back.

Other common symptoms of rectal prolapse include:

  • passing blood or mucus through the rectum
  • difficulty controlling bowel movements 
  • feeling that the rectum is not empty after a bowel movement
  • constipation 
  • diarrhea

Without treatment, these symptoms may worsen. Prolapses may happen more often, and they may not correct themselves when they do happen.

If you are experiencing symptoms of rectal prolapse, contact your doctor.

What causes rectal prolapse?

The exact cause of rectal prolapse is unknown. However, there are many possible risk factors for developing the condition.

These risk factors include:

  • chronic constipation
  • straining during bowel movements
  • a weakened pelvic floor or weak sphincter muscles
  • aging
  • genetics
  • structural issues with the ligaments
  • congenital bowel issues
  • trauma to the lower back or lower back disc disease
  • chronic conditions that increase pressure in the abdomen, such as chronic obstructive pulmonary disease
  • parasitic infection

How do doctors diagnose rectal prolapse?

Diagnosis will typically start with some questions about your medical history. Your doctor will generally want to know about any conditions you may have had in the past.

They will also typically perform a physical exam. During the exam, your doctor will examine your anus and rectum to check for signs of structural problems.

To confirm the diagnosis, your doctor may order some tests.

These may include:

  • Defecography: This uses X-rays or MRI to study the rectum for structural changes. It also uses barium, which is a liquid that shows up inside the body during imaging, to help visualize the structures under examination.
  • Colonoscopy: This uses a thin, lighted tube fitted with a camera to examine the rectum and large intestine.
  • Lower GI series: This uses X-rays and barium to study the large intestine.
  • Anorectal manometry: This is a simple outpatient procedure that measures the strength of the rectal and anal muscles.

What are the treatments for rectal prolapse? 

The most common treatment for rectal prolapse in adults is surgery. Even after surgery, recurrence is possible.

To reduce your risk of recurrence, you can try:

  • drinking more fluids to soften your stools and help prevent straining 
  • increasing your fiber intake to relieve constipation 
  • performing pelvic floor exercises to strengthen the pelvic floor 

Reducing and avoiding constipation is one of the main ways you can help prevent recurrences.

Read about stool softeners.

What are the potential complications of rectal prolapse?

In rare cases, rectal prolapse can lead to serious complications, such as:

  • Damage to the sphincter: Severe rectal prolapse can cause damage to the anal sphincters and raise the risk of bowel problems.
  • Strangulation: This is when blood does not flow to the part of the rectum that has dropped down. Strangulation requires immediate medical attention.
  • Ulcers in the rectum: Sores may form on the rectum if rectal prolapse is severe. In some cases, these sores may cause bleeding and pain.

Summary

Rectal prolapse occurs when the rectum falls down through the anus. Although the exact cause is unknown, there are several risk factors. These include having a weak pelvic floor, experiencing chronic constipation, and having spinal cord problems.

Symptoms of rectal prolapse can include passing blood or mucus, difficulty controlling bowel movements, and constipation or diarrhea.

To diagnose the condition, your doctor may perform a physical exam. They may also order some laboratory tests, such as defecography, colonoscopy, or lower GI series.

The main treatment method for rectal prolapse is surgery, which is effective in many cases. 

If you experience symptoms of rectal prolapse, contact your doctor.

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 Jun 14
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