Rectal Prolapse

What is rectal prolapse?

Rectal prolapse occurs when the rectum drops down through the anus. In complete rectal prolapse, the entire wall of the rectum drops through the anus. In partial rectal prolapse, only the lining of the rectum drops through the anus.

How common is rectal prolapse?

Rectal prolapse is relatively uncommon. A study conducted in Finland found that, each year, about 2.5 out of every 100,000 people are diagnosed with complete rectal prolapse.¹⁵

Who is more likely to get rectal prolapse?

Among adults, rectal prolapse is more common in those older than age 50 and more common in women than in men. About 80 to 90 percent of adults with rectal prolapse are women.¹⁶

Rectal prolapse is rare in children, and children with this condition are typically younger than age 4.¹⁷

What other health problems do people with rectal prolapse have?

Some women who have rectal prolapse have weak pelvic floor muscles. These women may have other problems related to weak pelvic floor muscles, such as

• a hernia of the intestines, called an enterocele
• bulging of the rectum into the front of the vagina, called rectocele
• bulging or dropping of the bladder into the vagina, called cystocele
• dropping of the uterus or vagina out of their normal positions, called uterine or vaginal prolapse

What are the complications of rectal prolapse?

The complications of rectal prolapse include

• ulcers in the rectum, which may cause bleeding
• a rectal prolapse that can’t be pushed back inside the body, which is a medical emergency because it can cut off the blood supply to the part of the rectum that has dropped through the anus
• damage to the sphincter muscles and nerves, causing or worsening bowel control problems (fecal incontinence)

What are the symptoms of rectal prolapse?

The symptoms of rectal prolapse include

• a reddish-colored mass that sticks out of the anus
• constipation or diarrhea or both
• feeling that the rectum is not empty after a bowel movement
• passing blood and mucus from the rectum
• fecal incontinence

Without treatment, symptoms such as constipation and bowel control problems may get worse. Over time, the rectum may drop through the anus more often and more easily. The rectum may not go back inside the body on its own and may need to be pushed back into place.

If you have symptoms of rectal prolapse, you should see a doctor for treatment. Treatment can help prevent symptoms from getting worse and prevent complications.

Seek medical help right away if you have symptoms of complications, such as heavy bleeding or a rectal prolapse that can’t be pushed back inside the body.

What causes rectal prolapse?

Experts aren’t sure what causes rectal prolapse. Certain structural defects and risk factors may increase the chance of rectal prolapse.

Structural defects

In adults with rectal prolapse, doctors have found certain defects in the pelvis or lower GI tract. These defects may increase the chance of rectal prolapse, or rectal prolapse may cause or worsen these defects. Structural defects often found in adults with rectal prolapse include

• a rectum that is not fixed in place and is able to move more than normal
• weak pelvic floor muscles
• weak anal sphincters

In children with rectal prolapse, doctors have found differences in the structure of the rectum. For example, the rectum may not have the usual curve and may be in a straight, vertical position, which may increase the chance of prolapse.

Risk factors

Certain conditions that increase pressure inside the abdomen or weaken the pelvic floor muscles may increase the chance of rectal prolapse. Examples include

• chronic constipation or straining during bowel movements
• chronic diarrhea
• cystic fibrosis
• diseases and disorders that affect the nerves or tissues of the pelvic floor muscle
• intestinal infections with certain parasites
• pelvic surgery
• whooping cough

How do doctors diagnose rectal prolapse?

To diagnose rectal prolapse, doctors ask about medical history and symptoms and perform a physical exam. In some cases, doctors also order tests.

Physical exam

Your doctor will examine your anus to see if you have a complete or partial rectal prolapse. If your doctor doesn’t see a prolapse, he or she may ask you to strain as if you are having a bowel movement to see the rectal prolapse. Your doctor may also perform a digital rectal exam.

Tests

Doctors may order tests to confirm the diagnosis of rectal prolapse or to check for other problems. These tests may include

• defecography, which uses x-rays or magnetic resonance imaging to create a video that shows how well your rectum can hold and empty stool and shows structural changes in your rectum and anus
• colonoscopy, which uses a long, flexible, narrow tube with a light and tiny camera on one end, to look inside your rectum and entire colon
• lower GI series, which uses x-rays and a chalky liquid called barium to view your large intestine

Doctors may order additional tests to check how well the nerves and muscles of your rectum and anus are working, such as anorectal manometry.

How do doctors treat rectal prolapse?

In adults, doctors most often treat rectal prolapse with surgery. Even after surgery, rectal prolapse can happen again. Reducing or avoiding constipation can lower the chance that it will happen again.

In children, doctors typically treat rectal prolapse by treating the underlying cause, such as constipation, straining during bowel movements, or diarrhea. If treating the cause doesn’t work, doctors may perform surgery to correct the prolapse.

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