Rectal Prolapse Tests and Procedures

Rectal prolapse evaluation begins with a medical history and anorectal examination. Depending on the symptoms and whether the prolapse is visible, a colorectal specialist may also recommend defecography, anorectal manometry, colonic transit testing, colonoscopy, or other pelvic-floor assessment.

If full-thickness rectal prolapse requires repair, surgery is generally performed through an abdominal approach, such as rectopexy, or a perineal approach, such as perineal rectosigmoidectomy or the Delorme procedure.

Why Testing May Be Needed

External prolapse is sometimes visible during an office examination, but additional testing may be useful when:

• The prolapse is intermittent or cannot be reproduced in the office
• Internal rectal prolapse is suspected
• Constipation or incomplete evacuation is prominent
• Stool leakage or fecal incontinence is present
• Another pelvic-floor disorder may be contributing
• Bleeding or bowel changes require additional evaluation
• Surgery is being planned

Not every patient needs every test. The evaluation should be selected according to the history, examination, bowel function, screening needs, and planned treatment.

Anorectal Examination

The initial assessment may include:

• Inspection of the anal and rectal area
• Digital rectal examination
• Evaluation while bearing down or straining when appropriate
• Assessment of anal sphincter tone
• Review of constipation, incomplete emptying, mucus drainage, bleeding, and stool leakage

If prolapse occurs only at home, a photograph taken during an episode may sometimes help the clinician understand what happened. It does not replace a physical examination or establish the diagnosis by itself.

Defecography

Defecography shows the rectum and pelvic floor during simulated evacuation. It may be performed with fluoroscopic X-ray imaging or MRI.

This test may help identify:

• Internal rectal prolapse or intussusception
• Rectocele
• Pelvic-floor descent
• Incomplete evacuation
• Abnormal coordination during defecation
• Other pelvic organs that descend during straining

Defecography can be particularly useful when the symptoms suggest obstructed defecation but no external prolapse is seen during the office examination.

Anorectal Manometry

Anorectal manometry uses a small flexible catheter to measure pressures, sensation, and reflexes in the anus and rectum.

It may be considered when a patient has:

• Fecal incontinence or difficulty controlling gas
• Constipation or difficult evacuation
• Suspected pelvic-floor dysfunction
• Symptoms that may influence treatment planning

Manometry provides functional information, but it does not replace visual examination or imaging when anatomic prolapse must be confirmed.

Colonic Transit Testing

Patients with severe or lifelong constipation may sometimes undergo a colonic transit study. The test tracks markers through the colon to estimate how quickly stool moves.

Transit testing may help determine whether constipation is related mainly to pelvic-floor evacuation, slow movement through the colon, or a combination of problems. This distinction can affect surgical planning in selected patients.

Colonoscopy

Colonoscopy does not usually demonstrate the prolapse itself, but it may be recommended to:

• Investigate rectal bleeding or changes in bowel habits
• Evaluate the colon for polyps, tumors, inflammation, or another source of symptoms
• Complete age- and risk-appropriate colorectal cancer screening
• Assess the colon before prolapse surgery when clinically indicated

Not every patient with rectal prolapse requires colonoscopy solely because prolapse is present.

Learn more about colorectal cancer screening and colonoscopy.

Surgical Procedures for Rectal Prolapse

For adults with symptomatic full-thickness rectal prolapse, surgery is generally the definitive treatment. The two broad operative routes are abdominal and perineal.

The correct operation depends on prolapse anatomy, constipation, fecal incontinence, pelvic-floor function, previous surgery, overall health, operative risk, and patient goals. For treatment selection and comparisons, see rectal prolapse treatment and surgery in Phoenix.

Rectopexy

Rectopexy is an abdominal operation in which the rectum is returned to its normal position and secured in the pelvis. Depending on the patient and operative plan, it may be performed through open, laparoscopic, or robotic surgery.

Techniques include suture rectopexy, ventral rectopexy, and resection rectopexy in selected patients. These operations differ in dissection, fixation, use of reinforcing material, and whether part of the sigmoid colon is removed.

Perineal Rectosigmoidectomy

Perineal rectosigmoidectomy, also called the Altemeier procedure, removes the prolapsed rectum and a portion of the distal sigmoid colon through the perineum. The remaining bowel is then reconnected near the anus.

It may be considered according to the length of prolapse, overall health, anesthetic risk, previous surgery, and surgeon assessment.

Delorme Procedure

The Delorme procedure is another perineal repair. The prolapsed mucosal lining is removed, and the underlying muscle is folded and tightened. It may be considered in selected patients with a shorter segment of full-thickness prolapse.

Preparing for Testing or Surgery

Preparation depends on the planned procedure and may include:

• Bowel preparation for selected colonoscopy or surgical procedures
• Temporary medication adjustments directed by the clinical team
• Review of anticoagulants, diabetes medications, and other relevant medicines
• Preoperative laboratory, cardiac, or anesthesia evaluation when indicated
• A plan to prevent constipation and excessive straining after treatment

Patients should follow the specific instructions provided for their test or operation rather than using a general preparation plan.

Questions to Ask Before a Procedure

Useful questions may include:

• What type of rectal prolapse do I have?
• Which tests are necessary in my case, and what will each test change?
• Is the proposed treatment abdominal or perineal?
• How might the procedure affect constipation or bowel control?
• What are the main risks and alternatives?
• What should I expect during recovery?
• What symptoms after the procedure require an urgent call?

When Urgent Evaluation Is Needed

Seek urgent medical care when prolapsed tissue cannot be returned inside, becomes dark or dusky, causes severe or rapidly worsening pain, or is accompanied by heavy bleeding, fever, fainting, or marked weakness.

Read when rectal prolapse may be an emergency.

Rectal Prolapse Evaluation in Phoenix

Dr. Aisha Akhtar, MD is a board-certified colon and rectal surgeon who evaluates rectal prolapse, bowel dysfunction, and related pelvic-floor conditions for patients in Phoenix, Scottsdale, Glendale, and surrounding Arizona communities.

Schedule a Rectal Prolapse Evaluation or call 602-932-5660.

For additional context, review what rectal prolapse is, rectal prolapse symptoms, or rectal prolapse images and diagrams.

Medical Sources

• American Society of Colon and Rectal Surgeons: Rectal Prolapse
• ASCRS Clinical Practice Guidelines for the Treatment of Rectal Prolapse

This page provides general educational information and does not replace an individualized medical examination, diagnosis, or treatment recommendation.

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