What is Rectal Prolapse? Symptoms, Causes, & Treatment

What is rectal prolapse?

Rectal prolapse happens when part or all of your rectum slips down and pushes through your anus, turning inside out like a sock. Think of it as the last part of your large intestine losing its normal position and sliding outward where it shouldn't be.

This condition affects people of all ages, though it's most common in older adults, particularly women over 50. While it might sound alarming, rectal prolapse is a treatable condition that doesn't pose immediate danger to your health.

The prolapse can range from mild, where just the inner lining slips down, to complete, where the entire thickness of the rectal wall protrudes outside your body. Understanding what's happening can help you feel more confident about seeking the right care.

What are the types of rectal prolapse?

There are three main types of rectal prolapse, each involving different layers of your rectal wall. Your doctor will determine which type you have to plan the best treatment approach.

Partial prolapse (mucosal prolapse) occurs when only the inner lining of your rectum slips down. This is the mildest form and often happens during bowel movements, then goes back into place on its own.

Complete prolapse (full-thickness prolapse) involves all layers of your rectal wall protruding through the anus. This type usually stays outside your body and requires manual pushing back in or medical intervention.

Internal prolapse (intussusception) happens when your rectum folds in on itself but doesn't come outside your body. While you can't see it, you might still feel symptoms like incomplete emptying or pressure.

What are the symptoms of rectal prolapse?

The symptoms of rectal prolapse can develop gradually and may vary depending on the severity of your condition. Many people notice changes in their bowel habits before seeing any visible signs.

Here are the most common symptoms you might experience:

• A visible bulge or mass protruding from your anus, especially during bowel movements
• Feeling like you can't completely empty your bowels
• Mucus or blood leaking from your rectum
• Pain or discomfort in your rectal area
• Difficulty controlling your bowel movements
• Straining more than usual during bowel movements
• A sensation of heaviness or pressure in your pelvis

Some people also experience less common symptoms that can significantly impact daily life. These might include chronic constipation, frequent urges to have bowel movements even when your bowel is empty, or lower back pain that seems related to your digestive issues.

In rare cases, you might develop more serious symptoms like severe bleeding, intense pain, or complete inability to control your bowels. These symptoms deserve immediate medical attention, as they could indicate complications that need prompt treatment.

What causes rectal prolapse?

Rectal prolapse develops when the muscles and ligaments that normally hold your rectum in place become weakened or stretched. This weakening allows your rectum to lose its anchor points and slip out of position.

Several factors can contribute to this weakening over time:

• Chronic straining during bowel movements from constipation
• Childbirth, particularly multiple vaginal deliveries
• Previous pelvic or anal surgery
• Chronic coughing from conditions like COPD
• Neurological conditions affecting nerve control
• Aging, which naturally weakens supporting tissues
• Chronic diarrhea putting stress on rectal muscles

Certain medical conditions can also increase your risk. Cystic fibrosis in children often leads to rectal prolapse due to frequent coughing and digestive issues. Neurological disorders like multiple sclerosis or spinal cord injuries can affect the nerve signals that help control your rectal muscles.

In some rare cases, congenital conditions present from birth can make the supporting structures around your rectum weaker than normal. Additionally, conditions that cause chronic increases in abdominal pressure, such as frequent heavy lifting or chronic urinary retention, can gradually contribute to prolapse development.

When to see a doctor for rectal prolapse?

You should schedule an appointment with your doctor if you notice any tissue protruding from your anus or experience persistent changes in your bowel habits. Early evaluation can help prevent the condition from worsening and improve treatment outcomes.

Seek medical care promptly if you experience bleeding from your rectum, especially if it's bright red or mixed with mucus. Changes in bowel control, persistent feeling of incomplete emptying, or ongoing pelvic pressure also warrant professional evaluation.

Consider emergency medical care if you develop severe pain, cannot push the prolapsed tissue back inside, or notice the protruding tissue has changed color to dark red or purple. These signs could indicate complications like strangulation, where blood flow to the tissue becomes compromised.

Don't feel embarrassed about discussing these symptoms with your healthcare provider. Rectal prolapse is a common condition that doctors diagnose and treat regularly, and early intervention often leads to better outcomes with less invasive treatments.

What are the risk factors for rectal prolapse?

Understanding your risk factors can help you take steps to prevent rectal prolapse or catch it early. Some factors you can influence through lifestyle changes, while others are beyond your control.

Age-related risk factors become more significant as you get older:

• Being over 65, when supporting tissues naturally weaken
• Female gender, particularly after menopause when hormonal changes affect tissue strength
• History of multiple pregnancies or difficult deliveries
• Previous pelvic floor dysfunction or prolapse of other organs

Medical conditions and lifestyle factors that increase your risk include chronic constipation requiring frequent straining, chronic obstructive pulmonary disease with persistent coughing, and neurological conditions affecting bowel control. Chronic diarrhea and inflammatory bowel diseases can also weaken rectal support structures over time.

Certain rare genetic conditions can predispose you to rectal prolapse from an early age. These include connective tissue disorders that affect the strength of your supportive tissues, and conditions like cystic fibrosis that cause chronic digestive and respiratory symptoms.

Your family history may also play a role, as some people inherit weaker connective tissues that make prolapse more likely. However, having risk factors doesn't mean you'll definitely develop rectal prolapse, and many cases occur in people without obvious risk factors.

What are the possible complications of rectal prolapse?

While rectal prolapse itself isn't immediately dangerous, leaving it untreated can lead to several complications that affect your quality of life and health. Understanding these potential issues can help motivate you to seek appropriate treatment.

The most common complications develop gradually and include:

• Chronic fecal incontinence, making it difficult to control bowel movements
• Recurrent urinary tract infections due to nearby anatomy changes
• Skin irritation and breakdown around your anus from constant moisture
• Worsening constipation as the prolapse interferes with normal bowel function
• Social isolation and anxiety from embarrassment about symptoms

More serious complications can occur if the prolapsed tissue becomes injured or its blood supply gets cut off. The exposed rectal tissue can develop ulcers from constant friction against clothing or toilet tissue, leading to bleeding and increased infection risk.

In rare cases, the prolapsed rectum can become strangulated, meaning its blood supply gets pinched off. This creates a medical emergency requiring immediate surgical intervention to prevent tissue death. Signs include severe pain, the tissue turning dark red or purple, and inability to push the prolapse back inside.

Some people also develop psychological complications from dealing with chronic symptoms. Depression, anxiety, and social withdrawal are common when bowel control issues interfere with daily activities and relationships.

How can rectal prolapse be prevented?

While you can't prevent all cases of rectal prolapse, especially those related to aging or genetic factors, several lifestyle strategies can significantly reduce your risk. Focusing on maintaining healthy bowel habits forms the foundation of prevention.

Preventing constipation is your most important step. Eat plenty of fiber-rich foods like fruits, vegetables, and whole grains to keep your stools soft and easy to pass. Drink adequate water throughout the day, aiming for about 8 glasses unless your doctor advises otherwise.

Avoid straining during bowel movements by never forcing or holding your breath while trying to pass stool. If you feel the urge, respond promptly rather than delaying. Consider using a footstool to elevate your knees slightly above your hips while sitting on the toilet, which can make elimination easier.

Strengthen your pelvic floor muscles through regular exercises like Kegels. These exercises involve repeatedly contracting and relaxing the muscles you use to stop urination midstream. Strong pelvic floor muscles provide better support for your rectum and other pelvic organs.

Maintain good overall health by staying physically active, which promotes healthy digestion and prevents constipation. If you have chronic cough from conditions like asthma or COPD, work with your doctor to manage it effectively to reduce strain on your pelvic area.

How is rectal prolapse diagnosed?

Diagnosing rectal prolapse usually starts with your doctor taking a detailed history of your symptoms and performing a physical examination. In many cases, the prolapse is visible during the exam, making diagnosis straightforward.

Your doctor will ask about your bowel habits, any pain or discomfort you're experiencing, and how long you've noticed symptoms. They'll also want to know about your medical history, previous surgeries, and any medications you're taking that might affect your digestive system.

During the physical exam, your doctor may ask you to strain or bear down as if having a bowel movement to see if the prolapse appears. They might also perform a digital rectal exam, gently inserting a gloved finger into your rectum to assess muscle tone and check for other abnormalities.

Additional tests may be needed to evaluate the extent of your prolapse and rule out other conditions. These might include a colonoscopy to examine your entire colon, specialized X-rays called defecography that show how your rectum functions during bowel movements, or anal manometry to measure the strength of your anal sphincter muscles.

In some cases, your doctor might order an MRI of your pelvis to get detailed images of your pelvic floor muscles and surrounding structures. This helps them understand the full extent of any pelvic floor dysfunction and plan the most appropriate treatment.

What is the treatment for rectal prolapse?

Treatment for rectal prolapse depends on the severity of your condition, your overall health, and how much the symptoms affect your daily life. Your doctor will work with you to choose the approach that offers the best chance of success with the least risk.

For mild cases, especially partial prolapse, conservative treatments are often tried first. These include dietary changes to prevent constipation, pelvic floor exercises to strengthen supporting muscles, and stool softeners to reduce straining during bowel movements.

Non-surgical options that might help include:

• High-fiber diet and increased fluid intake
• Regular pelvic floor muscle exercises
• Biofeedback training to improve bowel control
• Medications to manage constipation or diarrhea
• Supportive devices in rare cases for temporary relief

When conservative treatments don't provide adequate relief, surgery becomes the recommended option. Several surgical approaches exist, and your surgeon will choose based on your specific situation, age, and overall health status.

Abdominal surgeries involve making an incision in your abdomen to reach and repair the prolapse from above. These procedures typically have lower recurrence rates but require general anesthesia and longer recovery time. The surgeon may remove part of your colon if it's contributing to the problem.

Perineal surgeries are performed through the area around your anus and may be preferred for older patients or those with significant health conditions. While recovery is often faster, these procedures sometimes have higher recurrence rates than abdominal approaches.

In rare cases where surgery isn't possible due to severe health conditions, your doctor might recommend a colostomy. This creates an opening in your abdominal wall for waste elimination, bypassing the problematic rectal area entirely.

How to manage rectal prolapse at home?

While home management can't cure rectal prolapse, several strategies can help you feel more comfortable and prevent worsening while you await or recover from medical treatment. These approaches focus on reducing strain and supporting your body's natural healing processes.

Managing your bowel habits forms the cornerstone of home care. Establish regular bathroom times, preferably after meals when your digestive system is naturally more active. Never strain or hold your breath during bowel movements, as this increases pressure on your pelvic floor.

Dietary adjustments can make a significant difference in your comfort level:

• Eat high-fiber foods like beans, whole grains, and fresh fruits
• Drink plenty of water throughout the day
• Limit foods that can cause constipation like processed foods and excessive dairy
• Consider prunes or prune juice as a natural stool softener
• Eat smaller, more frequent meals to ease digestion

Practice proper bathroom positioning by using a small footstool to elevate your knees slightly above your hips while sitting on the toilet. This position naturally straightens your rectum and makes elimination easier without straining.

Keep the area around your anus clean and dry to prevent skin irritation. Use gentle, unscented wipes or rinse with warm water after bowel movements. Apply barrier creams if you experience leakage to protect your skin.

If you can safely push the prolapsed tissue back inside, wash your hands thoroughly first and use gentle pressure with a clean, damp cloth. Never force it, and seek immediate medical care if you can't reduce the prolapse or if it becomes painful.

How should you prepare for your doctor appointment?

Preparing for your appointment can help ensure you get the most accurate diagnosis and appropriate treatment plan. Gathering relevant information beforehand saves time and helps your doctor understand your situation completely.

Keep a symptom diary for at least a week before your appointment. Note when symptoms occur, what triggers them, and how they affect your daily activities. Include details about your bowel movements, any pain or discomfort, and whether you can push the prolapse back inside.

Make a list of all medications you're currently taking, including prescription drugs, over-the-counter medications, and supplements. Some medications can affect bowel function or complicate treatment options, so complete accuracy is important.

Write down questions you want to ask your doctor, such as:

• What type of rectal prolapse do I have?
• What treatment options are available for my specific case?
• What are the risks and benefits of surgery versus conservative treatment?
• How long will recovery take if I need surgery?
• What can I do at home to manage my symptoms?

Gather information about your family history, particularly any relatives who have had rectal prolapse, other pelvic organ prolapse, or chronic digestive issues. This information can help your doctor understand potential genetic factors.

Consider bringing a trusted friend or family member to your appointment. They can help you remember important information and provide emotional support during what might feel like an uncomfortable discussion.

What's the key takeaway about rectal prolapse?

Rectal prolapse is a treatable condition that, while uncomfortable and sometimes embarrassing, doesn't pose an immediate threat to your health. The most important thing to remember is that seeking medical care early often leads to better outcomes with less invasive treatments.

Many people successfully manage their symptoms through conservative approaches like dietary changes and pelvic floor exercises, especially when the prolapse is caught early. Even when surgery becomes necessary, modern techniques are highly effective with good long-term success rates.

Don't let embarrassment prevent you from getting the care you need. Healthcare providers are experienced in diagnosing and treating rectal prolapse, and they understand how significantly these symptoms can impact your quality of life. With proper treatment, most people return to normal activities and experience significant improvement in their symptoms.

Remember that rectal prolapse often develops gradually due to factors that build up over time. This means that the lifestyle changes you make today, such as maintaining healthy bowel habits and strengthening your pelvic floor muscles, can help prevent future problems and support your overall pelvic health.