What is rectal prolapse?

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

Rectal prolapse affects about 2.5 out of every 100,000 people. Women over age 50 are six times more likely than men to have this condition. Sometimes rectal prolapse is suspected, but 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.

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 has not 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.

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 movements and gas from your rectum.

Chronic constipation occurs in 30 to 67 percent of people with rectal prolapse, and about 15 percent experience diarrhea.

Surgery is typically required to help repair rectal prolapse and treat symptoms such as fecal incontinence and obstructed bowel movements.

Some types of surgery involve making an incision in the abdominal wall and pulling the rectum back into place. This surgery, also known as abdominal rectopexy, can also be performed laparoscopically, using smaller incisions with a special camera and tools.

There are also two different types of perineal rectosigmoidectomy, which are surgical procedures that repair the rectal prolapse through the perineum, or the area between the anus and genitals. These types are the:

  • Altemeier procedure. This type of surgery involves removing part of the rectum that is sticking out and reattaching the two ends back together.
  • Delorme procedure. This procedure is ideal for those with shorter prolapses. It involves removing the outer lining of the rectum and then folding and stitching the layer of muscle.

These surgeries are often recommended for people who have severe constipation and are not considered candidates for a laparoscopic procedure through the stomach.

After rectal prolapse surgery, you may need to stay in the hospital to recover and regain bowel function. The amount of time you spend in the hospital can vary depending on the specific type of surgery you had.

During your hospital stay, you will slowly transition from drinking clear liquids back to eating solid foods. Your doctor may also advise you on strategies to avoid a recurrence, or a return of rectal prolapse. These strategies may involve:

  • staying hydrated
  • eating enough fiber
  • using a stool softener to prevent constipation

Generally, most people are able to fully recover and return to their normal daily activities within 6 weeks of surgery.

Rectal prolapse can be caused by several medical conditions, including:

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

Weakened anal sphincter

This is the muscle that prevents stool from involuntarily passing from your rectum. Common reasons this muscle may weaken are:

  • pregnancy
  • childbirth
  • increased age

Chronic constipation

The strain of chronic bowel movement problems can make your rectum more likely to move down from its location. Straining 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 the risk of it, including:

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

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 is not significantly affected.

If the prolapse is mild, softening the stool can help you strain less during bowel movements so you may recover without surgery before it gets worse. However, surgery is the only way to definitively 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 are not suitable candidates for surgery through their abdomen.

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

Your doctor will ask about your medical history and have you describe your symptoms. 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 place 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 and hemorrhoids can both be uncomfortable and painful conditions. Rectal prolapse may initially feel like a bad case of hemorrhoids, and sometimes hemorrhoids on your anus may look like 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 are quite common in their smaller, milder form. They can become painful and itchy and can leave red blood on the 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 a doctor. They can diagnose your condition and start the appropriate treatment.

Preventing rectal prolapse is not always possible. You can reduce your risk if you maintain good intestinal health. To help avoid constipation:

  • Make high fiber foods part of your regular diet, including:
    • fruits
    • vegetables
    • bran
    • 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.

Rectal prolapse may be associated with several serious complications.

It often causes ulcers in the rectum, which could result in bleeding and pain.

It may also damage the sphincter, which is the ring-shaped muscle that opens and closes the anus. This can lead to issues with bowel control, including fecal incontinence.

In very severe cases, it may also cause strangulation, cutting off the blood supply to the part of the rectum that has pushed through the anus. This is considered a medical emergency and requires immediate surgical intervention.

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 6 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 will be.