Rectal Prolapse: Causes, Symptoms, and Treatment Options

Rectal prolapse is a condition in which part or all of the rectum (the final section of the large intestine) slips out of its normal position and protrudes through the anus. While it can be alarming to see or feel, rectal prolapse is not life-threatening in most cases. However, it can cause significant discomfort, hygiene problems, and social embarrassment if left untreated.

Dr. Prashanth, a leading GI and colorectal surgeon in Hyderabad, explains that rectal prolapse is more common in older adults—particularly women—but can occur at any age. With timely diagnosis and the right treatment, most patients can regain normal function and quality of life.

In this blog, we’ll look at what rectal prolapse is, why it happens, its symptoms, and the treatment options available today.

What Is Rectal Prolapse?

Rectal prolapse occurs when the rectum loses its normal support from surrounding muscles and ligaments, causing it to drop downward. In some cases, only the inner lining (mucosa) protrudes, while in others, the entire thickness of the rectal wall comes out through the anus.

Rectal prolapse is classified into three main types:

Internal prolapse – The rectum folds in on itself but does not protrude through the anus.
Partial prolapse (mucosal) – Only the mucosal lining of the rectum protrudes.
Complete (full-thickness) prolapse – The entire wall of the rectum protrudes through the anus.

Causes of Rectal Prolapse

The condition develops when the muscles, ligaments, and tissues that normally support the rectum become weakened or damaged. Common contributing factors include:

Chronic constipation – Straining during bowel movements increases pressure on rectal tissues.
Chronic diarrhea – Frequent bowel movements can also weaken pelvic support.
Pregnancy and childbirth – Vaginal deliveries, especially multiple or difficult ones, can stretch and weaken pelvic floor muscles.
Weak pelvic floor muscles – Often related to aging or hormonal changes in women after menopause.
Nerve damage – From spinal injury, pelvic surgery, or conditions like multiple sclerosis.
Previous rectal surgery – Which may alter the anatomy and support structures.
Long-standing hemorrhoids – Although distinct from prolapse, hemorrhoids can coexist and contribute to discomfort.

Genetic predisposition – Some people may have naturally weaker connective tissues.

Risk Factors

Rectal prolapse is more likely to occur in:

Women over 50 years old
People with chronic bowel disorders
Those with a history of pelvic surgery
Individuals with neurologic disorders affecting pelvic muscles

People who have a long history of straining during bowel movements

Symptoms of Rectal Prolapse

The symptoms depend on the type and severity of prolapse, but common signs include:

Visible protrusion from the anus – Initially occurs during bowel movements but may happen during coughing, sneezing, or even while standing.
A feeling of a lump or fullness in the anus
Mucus discharge – Leading to skin irritation and itching around the anus.
Bleeding – Small amounts of blood may appear on toilet paper or in the stool.
Fecal incontinence – Difficulty controlling gas or stool, especially in advanced cases.
Constipation or difficulty passing stool – Due to altered rectal anatomy.
Sensation of incomplete emptying – Even after bowel movements.

In early stages, the prolapse may retract on its own after bowel movements. Over time, it may require manual pushing back or remain protruded continuously.

How Rectal Prolapse Is Diagnosed

Diagnosis usually begins with a physical examination. In most cases, prolapse can be seen when the patient bears down during the exam. Additional tests may be needed to assess muscle strength, bowel function, and rule out other conditions:

Defecography (X-ray or MRI) – Visualizes the prolapse during simulated bowel movements.
Colonoscopy – Checks for other rectal or colon conditions, such as tumors or polyps.
Anorectal manometry – Measures the strength and coordination of anal muscles.
Endoanal ultrasound – Evaluates sphincter muscle integrity.

Treatment Options

The treatment for rectal prolapse depends on its severity, underlying causes, and the patient’s overall health.
1. Non-Surgical Management : In very early or mild cases, non-surgical measures may provide relief or slow progression:
- Dietary changes – Increasing fiber and fluids to prevent constipation.
- Bowel training – Establishing regular habits to reduce straining.
- Pelvic floor exercises (Kegels) – Strengthening muscles that support the rectum.
- Stool softeners – To make bowel movements easier.
However, these measures rarely reverse established prolapse. Surgery is often the definitive solution.
2. Surgical Treatments : Surgery is recommended for most moderate-to-severe cases, especially when prolapse causes incontinence, bleeding, or persistent discomfort.
Common surgical options include:
- Rectopexy – The rectum is repositioned and secured to the sacrum (lower spine) using sutures or mesh. Can be performed via open or laparoscopic (keyhole) surgery.
- Resection rectopexy – Combines rectopexy with removal of a portion of the sigmoid colon to improve bowel function.
- Perineal procedures – Such as the Altemeier (perineal rectosigmoidectomy) or Delorme procedure, often preferred for older or high-risk patients as they are less invasive and done through the perineum.
Dr. Prashanth specializes in minimally invasive approaches, which allow for faster recovery, less postoperative pain, and shorter hospital stays.

Recovery After Surgery

Recovery depends on the type of procedure and the patient’s health. General guidelines include:

Hospital stay of 1–3 days for laparoscopic procedures (longer for open surgery).
Gradual return to normal activities over 2–4 weeks.
Avoiding heavy lifting or straining during recovery.
Continuing a high-fiber diet and adequate hydration.
Performing pelvic floor exercises as recommended.

Preventing Recurrence

You should consult a doctor if you notice:

A lump or bulge from the anus, especially during bowel movements.
Persistent mucus or blood discharge.
Difficulty controlling bowel movements.
Ongoing constipation despite dietary changes.

Early evaluation allows for less invasive treatment and prevents complications such as ulceration or strangulation of the prolapsed tissue.

When to Seek Medical Advice

You should consult a doctor if you notice:

Pain or swelling near the top of the buttocks.
Pus or blood discharge from a small opening.
Recurrent infections in the same spot.
Fever with swelling in the area.

Early treatment can prevent the sinus from becoming complex or causing repeated abscesses.

The Bottom Line

Rectal prolapse is a treatable condition, but ignoring the symptoms can lead to worsening discomfort and loss of bowel control. Modern surgical techniques, especially minimally invasive procedures, offer excellent outcomes and rapid recovery for most patients.

Dr. Prashanth advises that anyone experiencing symptoms seek prompt medical evaluation, rather than living in silence or embarrassment. With the right treatment plan, you can regain comfort, confidence, and quality of life.