Rectal Prolapse

Rectal prolapse occurs when part or all of the rectum slips downward and protrudes through the anus. It may cause a bulge from the rectum, pelvic pressure, mucus drainage, bleeding, constipation, or stool leakage.

Rectal prolapse can range from mild internal prolapse to full-thickness prolapse that extends outside the body. Symptoms may gradually worsen over time, especially with chronic straining or weakening of the pelvic floor. Some patients can push the tissue back in temporarily, but persistent or recurrent prolapse often requires specialist evaluation.

Dr. Aisha Akhtar, a board-certified colorectal surgeon in Phoenix, specializes in diagnosing and treating rectal prolapse and other conditions affecting the colon, rectum, and anus.

What Is Rectal Prolapse?

Rectal prolapse is a condition in which the rectum loses its normal support and descends downward. In some cases, the prolapse remains internal. In other cases, the rectal tissue protrudes through the anal opening, particularly during bowel movements or straining.

Rectal prolapse is often confused with hemorrhoids because both can cause rectal bleeding, tissue protrusion, and discomfort, but they are different conditions and may require different treatment approaches.

Types of Rectal Prolapse

Rectal prolapse is generally classified as internal or external/full-thickness.

Internal Rectal Prolapse

Internal rectal prolapse occurs when the rectum folds into itself but does not protrude outside the anus. It may still cause obstructed defecation, pelvic pressure, incomplete evacuation, or discomfort.

Symptoms may include:

• A sense of blockage during bowel movements
• Incomplete emptying
• Pelvic or rectal pressure
• Straining with bowel movements

External or Full-Thickness Rectal Prolapse

External rectal prolapse occurs when the full thickness of the rectal wall protrudes through the anus. This form is more visible and may become harder to reduce over time.

Features of external rectal prolapse may include:

• A red bulge or protruding tissue from the anus
• Mucus drainage
• Bleeding or irritation
• Difficulty controlling stool or gas
• Need to manually push the prolapse back in

Common Symptoms of Rectal Prolapse

Symptoms of rectal prolapse often include:

• Tissue protruding from the anus
• Rectal pressure or fullness
• Mucus drainage
• Rectal bleeding
• Constipation or difficulty emptying
• Stool leakage or fecal incontinence

Learn more:

• Rectal Bleeding

What Causes Rectal Prolapse?

Rectal prolapse usually develops when the normal supporting tissues of the rectum weaken over time.

Common contributing factors include:

• Chronic constipation
• Repeated straining
• Pelvic floor weakness
• Aging
• Prior childbirth
• Chronic diarrhea in some cases
• Neurologic or connective tissue disorders in some patients
• Prior pelvic surgery in selected cases

The condition may worsen gradually as supporting tissues stretch and the rectum descends further with straining or bowel movements.

Internal vs External Rectal Prolapse

How Is Rectal Prolapse Diagnosed?

Diagnosis usually involves a medical evaluation that may include:

• Medical history review
• Physical examination
• Inspection of the anorectal area
• Examination during straining if needed
• Additional testing if symptoms suggest internal prolapse or another pelvic floor disorder

In many cases, the prolapse can be identified during examination. Further evaluation may be recommended if symptoms are intermittent or if other anorectal or pelvic floor conditions need to be ruled out.

These evaluations help distinguish rectal prolapse from:

• Hemorrhoids
• Rectal mucosal prolapse
• Solitary rectal ulcer syndrome
• Pelvic floor dysfunction
• Other causes of rectal bleeding or tissue protrusion

Treatment Options for Rectal Prolapse

Treatment depends on whether the prolapse is mild or advanced and how severe the symptoms are.

Conservative Treatment

Mild symptoms may sometimes be managed with non-surgical care such as:

• Increasing dietary fiber
• Drinking more fluids
• Stool softeners
• Avoiding straining
• Treating constipation
• Pelvic floor support measures in selected patients

These measures may improve symptoms and reduce worsening, but they do not typically correct full-thickness rectal prolapse.

Medical Treatment

If symptoms persist, treatment may include directed management of bowel dysfunction and associated pelvic floor symptoms.

Medical treatment may include:

• Treatment for constipation
• Treatment for diarrhea if present
• Symptom-directed bowel management
• Specialist evaluation for associated pelvic floor disorders

Surgical Treatment

For persistent, symptomatic, or full-thickness rectal prolapse, procedural or surgical treatment may be recommended.

Treatment options may include:

• Abdominal rectopexy
• Perineal rectosigmoidectomy
• Other prolapse repair procedures based on anatomy and patient factors

Surgical treatment is usually considered when symptoms are persistent, the prolapse is recurrent, or the prolapse cannot be managed adequately with conservative measures.

When Should You See a Doctor?

You should seek medical evaluation if you experience:

• Tissue protruding from the anus
• Rectal bleeding or mucus drainage
• New stool leakage
• Constipation with obstructed bowel movements
• Difficulty pushing the prolapse back in
• Increasing pain, swelling, or discoloration
• Symptoms that do not improve with home treatment

Rectal bleeding or protruding tissue should always be evaluated to rule out other colorectal conditions.

Related Conditions and Treatments

You may also want to review:

• Hemorrhoids
• Rectal Bleeding
• Constipation
• Rectal Prolapse Treatment

Learn More About Rectal prolapse

You may also explore these guides:

• Rectal prolapse Overview
• Rectal prolapse Symptoms
• Rectal prolapse Procedures
• Rectal prolapse FAQ
• Rectal prolapse Images & Diagrams