Rectal prolapse is uncommon, and the exact cause is not clear. It appears to be linked to an injury to the muscle or nerves of the rectum.
Both rectal prolapse and hemorrhoids have similar symptoms. Sometimes this can make diagnosis difficult.
Rectal prolapse can be so severe that it limits your quality of life. But lifestyle modifications or surgery can treat it.
Rectal prolapse happens when the rectum pushes through the anus opening. The rectum is the last part of the colon (large intestines), and the anus is where stool exits your body. Prolapse can happen when the rectum loses the normal attachments that keep it inside the body. This can cause the rectum to turn itself “inside out.”
Rectal prolapse is not a very common medical condition. It affects fewer than 3 out of 100,000 people. It most commonly affects adults over the age of 50, though it can occur in infants as well.
Experts do not know the specific cause of rectal prolapse. It may be linked to nerve and muscle injury to the rectum. There are several conditions that can increase your risk of developing rectal prolapse. These include:
Pregnancy and childbirth
Spinal cord problems
Cystic fibrosis (a respiratory and digestive disorder)
Symptoms of rectal prolapse can range from mild to severe. Many people describe a feeling of something coming out of the anus after a bowel movement that they have to push back in. Other symptoms can include:
Beefy-red bulge that sticks out of the anus
Passing blood or mucus from the anus
Inability to completely empty the rectum with bowel movement
It’s common to confuse rectal prolapse with hemorrhoids. This is because they have similar symptoms. Your provider can do an exam to help tell the two apart and make the right diagnosis.
Diagnosis of a rectal prolapse usually happens after a detailed conversation with your healthcare provider. They’ll ask about your medical history and details about your bowel movements. Don’t let feelings of embarrassment or shame prevent you from having an open and clear conversation. The more details you can share with your provider, the better.
Your healthcare provider will also perform a complete physical examination. They may ask you to squat and pretend that you’re having a bowel movement. This is so they can visualize your rectum. They’ll also likely perform a rectal exam by placing a gloved finger in the anus.
Other tests may be useful in confirming the diagnosis of rectal prolapse. They may also help to check for other conditions as the cause of your symptoms. These can include:
Endoscopy: Your provider inserts a flexible, lighted tube with a camera into the anus. This allows them to look at the inside of the anus and rectum.
MR defecography: This test uses magnetic radiation to provide pictures of the anus, rectum, and pelvic floor muscles. During the test, your provider will ask you to have a bowel movement. This is so you can release the contrast they placed in the rectum.
You may have your rectum prolapse with each bowel movement or at various times during the day. When this happens, you should be able to push the rectum back into place with gentle pressure. But this is not a permanent solution.
Without treatment, the rectum will likely continue to fall out of the anus. The rectum may fall out again at your next bowel movement or unexpectedly throughout the day.
In most cases, you can push a prolapsed rectum back into place with gentle pressure. If at any time you can’t push the rectum back into the body, you should contact your provider immediately. You may also need to seek emergency care if you have symptoms like:
Increased rectal bleeding
Nausea or vomiting
Inability to eat or drink
Inability to pass gas or stool
Change in color of the prolapsed rectum (from reddish to dark purple or black)
Once your healthcare provider confirms the diagnosis of rectal prolapse, together you’ll agree on a treatment plan.
Surgery is the definitive treatment for rectal prolapse. If you choose to have surgery, your surgeon may discuss your surgical options. There are two approaches to fixing rectal prolapse with surgery:
Abdominal approach (through the belly): This surgery pulls the rectum back into the body, reconnecting it to its normal position. Sometimes you may have a piece of your colon removed at the same time. Your surgeon can use a large abdominal incision or a minimally invasive technique.
Perineal approach (through the bottom): Your surgeon removes a section of your intestines through the area around the anus. After removing the prolapsed rectum, they suture the remaining colon to the anus.
Your provider will help you decide which surgical approach is best for you. Even after surgery, sometimes rectal prolapse can happen again. That’s why it’s important to incorporate lifestyle changes.This may help to reduce how often prolapse happens.
These lifestyle and dietary changes can include:
Dietary changes: Increasing dietary fiber can help. Fiber bulk up your stools and makes bowel movements more regular. Increasing water intake prevents constipation.
Kegel exercises: These exercises help strengthen your pelvic floor muscles. Strong pelvic floor muscles provide better support for the rectum.
Rectal prolapse is uncommon, but it can be disruptive when it happens. There’s no known cause, but some conditions that can weaken the rectum put you at greater risk. Sometimes you can manage the symptoms with changes in lifestyle and diet.
Surgery is the only definitive treatment for rectal prolapse, but prolapse can recur after surgery. If you’re having symptoms of rectal prolapse, notify your provider right away. They can help figure out the best treatment plan for you.
American Society of Colon and Rectal Surgeons. (n.d.). Rectal prolapse expanded version.
El-Chammas, K., et al. (2015). Rectal prolapse and cystic fibrosis. Journal of Pediatric Gastroenterology and Nutrition.