Rectal prolapse is a medical condition in which the rectum starts to push through the anus. The rectum is that last part of your large intestine, and the anus is the opening through which stool exits your body.

Rectal prolapse affects about 2.5 people out of 100,000. Women over 50 are six times more likely than men to have this condition. It’s often suspected when the problem is actually a serious case of hemorrhoids.

Rectal prolapse can range from mild to severe. Mild cases can often be treated without surgery. Severe cases may require surgery.

The symptoms of rectal prolapse tend to come on slowly. The first symptom you’ll notice is the feeling that there is a bulge at your anus. It may seem as though you are sitting on a ball.

With a mirror, you may be able to see a reddish-colored bulge peeking through or actually extending out of your anus. Sometimes during a bowel movement, a small part of the rectum will emerge, but may retreat on its own or be easily pushed back into place.

Normal physical activity, such as walking, sitting, and exercising, may also cause part of the rectum to push through your anus. At first, it can be returned to its proper location by hand.

If rectal prolapse worsens, there could be bleeding from the inner lining of the rectum. In cases of partial or complete prolapse, you may have trouble controlling liquid or solid bowel movement and gas from your rectum.

Up to half of the people with rectal prolapse experience constipation, while others may have episodes of constipation and incontinence.

There are three types of rectal prolapse. The type is identified by the movement of the rectum:

  • Internal prolapse: The rectum starts to drop, but hasn’t yet pushed through the anus.
  • Partial prolapse: Only part of the rectum has moved through the anus.
  • Complete prolapse: The entire rectum extends out through the anus.

Rectal prolapse can be caused by several medical conditions. They include:

Nerve damage

If nerves that control the rectal and anal muscles are damaged, rectal prolapse can develop. These nerves can sometimes be damaged from:

  • pregnancy or during a difficult vaginal birth
  • a spinal injury
  • surgery in the pelvic area

Weakened anal sphincter

This is the muscle that allows stool to pass from your rectum. Common reasons for this muscle to weaken are pregnancy and childbirth, or increased age.

Chronic constipation

The strain of chronic bowel movement problems can make your rectum more likely to move down from its location. Strain while having bowel movements, if done often over a period of years, can also cause rectal prolapse.

While not directly linked to rectal prolapse, some conditions may increase your risk for it, including:

Women over the age of 50 are also at an increased risk of rectal prolapse.

Rectal prolapse and hemorrhoids can both be uncomfortable and very painful conditions. Rectal prolapse may initially feel like a bad case of hemorrhoids, and sometimes hemorrhoids on your anus may look as though your rectum is emerging.

Rectal prolapse involves movement of the rectum itself. Hemorrhoids are actually swollen blood vessels in the walls of your rectum or anus. Hemorrhoids, though quite common in their smaller, milder form, can become painful and itchy. They can leave red blood on tissue when you wipe. Rectal prolapse can also cause bleeding sometimes.

Read more: Why is there blood when you wipe? »

If you suspect you have hemorrhoids or rectal prolapse, see your doctor. They can diagnose your condition and start the appropriate treatment.

Your doctor will have you describe your symptoms and ask about your medical history. They should also do a complete physical examination. During your exam, your doctor may ask you to squat and strain as though you were having a bowel movement. Your doctor will observe your rectum and may placed a gloved finger in your anus to check the health or strength of the anal sphincter and the rectum itself.

You may also be directed to have a colonoscopy to check for any polyps.

Rectal prolapse won’t get better on its own. The degree of prolapse will increase over time. This process can take months or years, so there isn’t always a rush to make a decision.

If you’ve been diagnosed with rectal prolapse, you may choose to delay treatment if your symptoms are mild enough and your quality of life isn’t significantly hampered.

Surgery is the only way to effectively treat rectal prolapse and relieve symptoms. The surgeon can do the surgery through the abdomen or through the area around the anus.

Surgery through the abdomen is performed to pull the rectum back up and into its proper position. It can be done with a large incision and open surgery, or it can be done laparoscopically, using a few incisions and specially designed smaller surgical tools.

Surgery from the region around the anus involves pulling part of the rectum out and surgically removing it. The rectum is then placed back inside and attached to the large intestine. This approach is usually performed in people who aren’t good candidates for surgery through their abdomen.

Discuss your options with your doctor. If they recommend one type of surgery, you should feel comfortable asking why it’s recommended.

The outlook is generally positive for someone undergoing rectal prolapse surgery. You’ll be on a diet of liquids and soft foods for a while, and you’ll need to take a stool softener at first. This is to prevent constipation or straining during a bowel movement.

The amount of time spent in the hospital after surgery depends on your health and the type of surgery you had. A full recovery can be expected in about six weeks.

Rectal prolapse can be uncomfortable and painful, but it’s treatable. The sooner you see a doctor about your symptoms, the easier the surgery and recovery.

Preventing rectal prolapse isn’t always possible. You can reduce your risk if you maintain good intestinal health. To help avoid constipation, in particular:

  • make high-fiber foods part of your regular diet, including fruits, vegetables, bran, and beans
  • reduce the amount of processed food in your diet
  • drink plenty of water and fluids every day
  • exercise most, if not all, days of the week
  • manage your stress with meditation or other relaxation techniques