Rectal Prolapse

Rectal Prolapse

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Rectal prolapse occurs when your rectum, part of your large intestine, slips down inside your anus. It’s caused by a weakening of the muscles that hold it in place. Rectal prolapse may look or feel like hemorrhoids, but unlike hemorrhoids, it doesn’t go away on its own. You'll eventually need surgery to fix it.

Prevention

How can I prevent rectal prolapse from occurring or from recurring after surgery?

Treat chronic bowel disorders . Don’t let chronic constipation or diarrhea persist. Ask your healthcare provider about treatment options, including lifestyle changes and medications.
Strengthen your pelvic floor . Kegel exercises can help keep your pelvic muscles fit and strong. They have been shown to prevent incontinence as well as possible pelvic organ prolapse.

American Society of Colon and Rectal Surgeons. Rectal Prolapse Expanded Version. (https://fascrs.org/patients/diseases-and-conditions/a-z/rectal-prolapse-expanded-version) Accessed 6/7/2022.
National Institute of Diabetes and Digestive and Kidney Diseases. Rectal Prolapse. (https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract/rectal-prolapse) Accessed 6/7/2022.
National Institutes of Health, National Library of Medicine. Rectal Prolapse. (https://medlineplus.gov/ency/article/001132.htm) Accessed 6/7/2022.

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Your rectum is the last segment of your large intestine before your anus. This is where poop prepares to exit your body. When poop arrives in your rectum, it triggers the urge to defecate (poop), and a network of muscles pushes the poop out through your anus. But when rectal prolapse occurs, the rectum itself travels with it, slipping down telescope-style into the anal canal — and sometimes out the other side.
“Prolapse” is the term healthcare providers use to describe any body part that has fallen from its normal position in your body. It usually means that the muscles supporting the part have weakened or deteriorated. Some weakening or deterioration is normal with aging, but extra wear and tear on the muscles can accelerate the process. Childbirth, chronic constipation or diarrhea can affect your rectum.

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It most commonly affects people who were assigned female at birth, especially those over the age of 50. Less commonly, it may occur in young children as a result of chronic diarrhea or cystic fibrosis .
It’s estimated to occur in about 2.5 in every 1000 people.
It’s not urgently serious, but it can cause discomfort for some people, and it can lead to possible complications down the road. The most common complications are pooping difficulties, such as fecal incontinence .
Failure of the muscles that hold the rectum in place leads to rectal prolapse. Many things may contribute to this. Some possibilities include:
Rectal prolapse can look different in different people. If you have an internal prolapse, your rectum has begun to drop partway into your anus, but it hasn’t yet come out the other end. If you have a mucosal prolapse, the inside mucous lining of your rectum has turned inside-out and begun to poke out of your anus. External prolapse is when your entire rectum falls out. At first, prolapse may only occur when you poop, but eventually, it's constant.
Rectal prolapse and hemorrhoids can have similar symptoms, and it's not uncommon to mistake one for the other. Hemorrhoids — swollen blood vessels in the anus or rectum — can also cause itching, pain or bleeding. Hemorrhoids can even prolapse — slip out of your anus — and they may look similar to mucosal rectal prolapse if they do. After all, they occur within the same red, fleshy mucous lining.
Both hemorrhoids and rectal prolapse can occur during and after pregnancy, or in conjunction with chronic constipation or diarrhea. While rectal prolapse has many possible causes, hemorrhoids are mainly caused by excessive straining. They are also temporary and will go away on their own after a week or so. Rectal prolapse is chronic and progressive. The symptoms may change, but it won’t go away.
Your healthcare provider will review your medical history, then examine your rectum. They might ask you to activate your muscles as if you were pooping. To confirm the diagnosis or rule out other possible problems, they might use one or several of the following tests:
If you have weak pelvic floor muscles, you may have one or several other conditions in addition to rectal prolapse. Your healthcare provider may want to check for these other conditions so that they can address them all together. Possible secondary conditions include:
Not in adults. If rectal prolapse occurs in your child, it might go away after you treat the cause. For example, if your child has hard stools, diarrhea or a parasite infection, treating these conditions will relieve the stress on their pelvic floor muscles. The muscles will repair themselves as your child continues to grow. If you’re an adult, however, rectal prolapse won’t improve without surgery.
If it's not causing bothersome symptoms, you may be able to live for some time with rectal prolapse, taking care of it at home. Taking care of it means pushing your rectum back inside manually. Healthcare providers recommend that you lie on your side with your knees to your chest and use a wet, warm cloth to gently push your rectum back into place. However, prolapse will continue to worsen over time.
Untreated rectal prolapse can lead to several possible complications, including:
There are several surgical approaches to fixing rectal prolapse. Which procedure you have will depend on the specifics of your condition. For generally healthy adults, the first choice is usually a rectopexy , which is a procedure to repair your rectum through your abdomen. However, some people might not be good candidates for abdominal surgery. In these cases, rectal surgery is another option.
This procedure restores your rectum to its original position in your pelvis. Your surgeon will attach your rectum to the back wall of your pelvis (your sacrum) with permanent stitches. They may also reinforce it with mesh. These will hold your rectum in place long enough for scar tissue to develop, which will hold it in place after that. Rectopexy has a 97% long-term success rate in fixing rectal prolapse.
Depending on the judgment and experience of your surgeon, you may have your rectopexy by either open abdominal surgery or minimally invasive (laparoscopic) surgery. Open surgery means opening up your abdominal cavity to access your organs. Laparoscopic surgery is done through small “keyhole” incisions, using a small camera, and is sometimes done with the use of a surgical robot. Both procedures are done under general anesthesia .
If you've had a history of chronic constipation, and if this was a contributing factor to your rectal prolapse, your surgeon may suggest a partial bowel resection at the time of your rectopexy. That means removing a section of your colon. Your surgeon can identify the part of your colon where difficulties with constipation tend to occur. Removing the problem section often improves bowel function afterward.
If abdominal surgery isn’t an ideal option for you, your surgeon may approach your rectal prolapse through your anus. Rectal surgery doesn’t always require general anesthesia as abdominal surgery does. Some people can have it with epidural anesthesia . The rectal or “perineal” approach may also be a better choice if you have a very minor prolapse, or if your rectum is stuck on the outside (incarcerated). There are two common procedures:
Altemeier procedure . In this procedure, your surgeon pulls the prolapsed rectum out through your anus and removes it. They may also remove the lower part of the colon (sigmoid colon) if it is involved in the prolapse ( proctosigmoidectomy ). Then they sew the two ends of your large intestine (your remaining colon and your anus) back together. The new end of your colon now becomes your new rectum.
This procedure is less invasive than open abdominal surgery and easier to recover from, but its disadvantage is that prolapse may recur afterward. One reason is that the new rectum made from your colon is not as strong as your original rectum was. Because of this, some surgeons combine the altemeier procedure with a “levatoroplasty” — tightening the pelvic floor muscles by sewing them closer together.
Delorme procedure . If you only have a mucosal prolapse, or a small external prolapse, your surgeon may choose a more minor procedure. The Delorme procedure only removes the prolapsed mucosal lining of your rectum. Your surgeon then folds back the muscle wall of the rectum onto itself and stitches it together inside your anal canal. The double muscle wall helps to reinforce the rectum.
All surgeries come with a low risk of certain general complications, including:
Additional risks associated with rectal prolapse surgery include:
It may not be a major problem at first, but it will continue to get worse over time. If you already have bowel problems, you should probably see your healthcare provider sooner than later. Most of the time, surgery will fix rectal prolapse, but it may return in a small number of people. Surgery also has mixed results for bowel complications. These problems may need additional treatment to be solved.
Rectal prolapse is usually the result of a long, gradual process of muscle deterioration. It’s not a medical emergency, but it can be dismaying when it occurs. Some deterioration is inevitable, but self-care can make a difference. By paying attention to your bowel health and exercising your pelvic floor muscles, you can help keep your pelvic organs in the best condition possible. If prolapse does occur, surgery can fix it.
Last reviewed by a Cleveland Clinic medical professional on 06/07/2022.

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Authored by Dr Laurence Knott , Reviewed by Dr Helen Huins | Last edited 2 Jun 2017 | Meets Patient’s editorial guidelines
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Rectal prolapse causes a lump to stick out of your back passage (anus) and this can become quite painful. Although the lump can pop in and out at first, later on it can stay out all the time, especially when you stand up. This can cause problems with daily activities that involve walking or standing for any length of time.
In children, rectal prolapse can occur in:
Click on the links for more information about the highlighted conditions.
Prolapse of the bladder or womb (uterus) doesn't cause rectal prolapse but is sometimes associated with it.
No-one knows how common rectal prolapse is because people often have it without reporting it to their doctor. However, it is known to happen most frequently in the elderly. Women seem to be more prone to it than men.
It is occasionally seen in children, especially from the ages of 1 to 3 years.
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An intussusception occurs when a section of bowel folds into the next section, a bit like the way a telescope folds up. Sometimes the folded bowel pokes outside the back passage (anus) and looks like a rectal prolapse.
A rectal polyp is a thickening of the lining (mucosa) of the bowel that comes to resemble a finger-like structure growing out of the side wall of the gut. If it pokes outside the anus it can resemble a rectal prolapse.
What we know as a pile is a large vein that usually develops from straining whilst going to the loo. This is yet another condition that can look like a rectal prolapse if it pokes outside the anus.
Difference between rectal prolapse and haemorrhoids
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Studies suggest that there is no difference in success rate whichever surgical procedure is used. Your surgeon will discuss the best option, taking on board your age, general health, previous experience with anaesthetics and how long you have had your prolapse. In general, young fit people are better off having a procedure through the tummy (abdomen). Older people may be more suited to perineal operations which can be done under local anaesthetic. There's more of a chance of the prolapse coming back but less risk to your health if you're a bit frail.
The outlook (prognosis) will depend on your age, on whether you have any untreatable causes for the prolapse and on the state of your general health.
About 1 in 10 children who have a rectal prolapse will continue to have it when they grow up, especially if they are aged over 4 years when they first develop it.
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Murphy PB, Wanis K, Schlachta CM, et al ; Systematic review on recent advances in the surgical management of rectal prolapse. Minerva Chir. 2017 Feb72(1):71-80. doi: 10.23736/S0026-4733.16.07205-9. Epub 2016 Oct 6.
Shin EJ ; Surgical treatment of rectal prolapse. J Korean Soc Coloproctol. 2011 Feb27(1):5-12. doi: 10.3393/jksc.2011.27.1.5. Epub 2011 Feb 28.
Yang SJ, Yoon SG, Lim KY, et al ; Laparoscopic Vaginal Suspension and Rectopexy for Rectal Prolapse. Ann Coloproctol. 2017 Apr33(2):64-69. doi: 10.3393/ac.2017.33.2.64. Epub 2017 Apr 28.
Sarmast MH, Askarpour S, Peyvasteh M, et al ; Rectal prolapse in children: a study of 71 cases. Prz Gastroenterol. 201510(2):105-7. doi: 10.5114/pg.2015.49003. Epub 2015 Feb 10.
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Cohee MW, et al. Benign anorectal conditions: Evaluation and management. American Family Physician. 2020;101:24.
Rectal prolapse. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract/rectal-prolapse. Accessed March 26, 2021.
Rectal prolapse. American Society of Colon & Rectal Surgeons. https://fascrs.org/patients/diseases-and-conditions/a-z/rectal-prolapse-expanded-version. Accessed March 22, 2021.
Tsunoda A. Surgical treatment of rectal prolapse in the laparoscopic era; A review of the literature. Journal of the Anus, Rectum and Colon. 2020; doi:10.23922/jarc.2019-035.
Varma MG, et al. Surgical approach to rectal procidentia (rectal prolapse). https://www.uptodate.com/contents/search. Accessed March 26, 2021.
Varma MG, et al. Overview of rectal procidentia (rectal prolapse). https://www.uptodate.com/contents/search. Accessed March 26, 2021.
Morrow ES. Allscripts EPSi. Mayo Clinic. April 16, 2021.

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Sometimes it can be difficult to distinguish rectal prolapse from hemorrhoids. To help diagnose rectal prolapse and rule out other associated conditions, your doctor may recommend:
Treatment for rectal prolapse usually involves surgery. Other treatments include various therapies for constipation, including stool softeners, suppositories and other medications. There are a few different surgical methods for treating rectal prolapse. Your doctor will choose the best approach for you after considering your age, physical condition and bowel function.
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Medically Reviewed by Minesh Khatri, MD on September 02, 2022
Prolapse is when any body part slips or falls down from its normal position. Rectal prolapse is when your rectum -- the last section of your large intestine -- drops down or slides out of your anus . While that may sound scary, it’s typically not considered a medical emergency. However, the longer you have the condition, the worse it can get. Living with rectal prolapse can cause embarrassment and affect your quality of life.
If you feel like something just isn’t right when you go to the bathroom, or try to poop , you shouldn’t ignore it or make light of it. Your doctor can diagnose rectal prolapse and suggest treatment to fix it.
If you feel like you’re sitting on a ball after pooping, or if you notice that you have something sticking out of the opening (your anus) where you poop, you could have rectal prolapse.
Typically, you’ll first experience rectal prolapse after you have a bowel movement. The first time, or first few times, the rectum may return inside on its own. Later, you may feel like something has fallen out of
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