What Is Rectal Prolapse?
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 . (Some may call this prolapsed anus, but it's the rectum that drops.) Rectal prolapse is not usually considered a medical emergency. But the longer you have the condition, the worse it can get. Living with rectal prolapse can cause embarrassment and affect your quality of life.
Rectal prolapse happens in about 2.5 out of every 1,000 people. It's more common in people assigned female at birth. You are more likely to have rectal prolapse after age 50, but it does happen in children who have issues like chronic diarrhea or cystic fibrosis.
If you feel like something 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.
Types of Rectal Prolapse
There are three types of prolapse:
External prolapse: The entire rectum sticks out of your anus.
Mucosal prolapse: Part of the rectal lining pokes out of your anus.
Internal prolapse: The rectum has started to drop but is not yet sticking out of your anus.
Rectal Prolapse Symptoms
If you feel like you’re sitting on a ball after pooping, or notice that you have something sticking out of the opening where you poop (your anus), you could have rectal prolapse.
The first time you notice your rectum has dropped is usually after you have a bowel movement. When it first happens, the rectum may return inside on its own. Later, you may feel like something has fallen out of your body, or you just feel something down there that isn’t normal. In those cases, you may be able to push the rectum back in yourself.
Additional symptoms of rectal prolapse can include:
- Feeling a bulge outside your anus
- Seeing a red mass outside your anal opening
- Pain in the anus or rectum
- Anal itching
- Not being able to control when you poop (fecal incontinence)
- Bleeding from the rectum
- Leaking blood, poop, or mucus from the anus
Rectal prolapse vs. hemorrhoids
Early on, rectal prolapse may look like hemorrhoids slipping out of your anal opening, but these are two different conditions. Hemorrhoids are swollen blood vessels in your anus or lower rectum that may cause itching, pain, and blood on the toilet paper when you wipe after you poop. Your doctor can diagnose whether you have rectal prolapse or hemorrhoids.
Rectal Prolapse Causes
A variety of things can cause rectal prolapse, including:
- Long-term history of diarrhea or constipation
- Cystic fibrosis, a condition that causes breathing and stomach problems
- Intestinal parasite infection
- Chronic coughing or sneezing
- Long-term history of having to strain when you poop
- Aging, which can lead to weakening of muscles and ligaments in the rectal area
- Previous injury to the anal or hip area
- Nerve damage that affects your muscles’ ability to tighten and loosen, which could be caused by pregnancy, vaginal childbirth complications, anal sphincter paralysis, or injury to your spine or back
- Neurological problems, such as spinal cord disease or spinal cord transection
Rectal Prolapse Risk Factors
Rectal prolapse is more common in people assigned female at birth, especially as they age. In general, older people who have had a history of constipation or problems with their pelvic floor have a higher chance of having a prolapsed rectum.
Other things that put you at higher risk for rectal prolapse include:
- Chronic constipation
- Always having to strain to poop
- Lower back injury or disk disease
- Muscle weakness in your anus or pelvic floor
- If someone in your family also had rectal prolapse
- Parasitic infections like schistosomiasis
- Chronic obstructive pulmonary disease (COPD)
- Benign prostatic hypertrophy (growth of the prostate gland)
- Any injury or problems with ligaments that keep your rectum attached to the intestinal wall
- Congenital bowel disorders like Hirschsprung’s disease or neuronal intestinal dysplasia
Rectal prolapse in children
Rectal prolapse is not common in children, but it can happen to those with:
- Chronic constipation/straining while pooping
- Chronic diarrhea
- Poor nutrition
- Cystic fibrosis
- Spinal cord injury or a tethered cord
- Issues with the colon and pelvis like Hirschsprung's disease (a condition where a child's bowels don't have enough nerve cells so they can't pass waste, leading to blockages)
- Anal penetration, potentially from sexual abuse
If your child has a prolapsed rectum, it can often be treated by their pediatrician. If they have a chronic condition like cystic fibrosis, they may need to see a specialist for more treatment or surgery.
Rectal Prolapse Diagnosis
It may be difficult for your doctor to know if you have hemorrhoids, another condition, or rectal prolapse. Because of this, your doctor may recommend one of several tests. These include:
Digital rectal exam
During this test, your doctor will place a gloved finger in your anus to check the strength of the muscles.
Anal electromyography (EMG)
This test checks to see if nerve damage is causing your anal sphincter problems.
A thin tube is inserted into your rectum to test muscle strength.
A probe inserted into your anus and rectum is used to examine muscles and tissues.
Pudendal nerve terminal motor latency test
It checks your pudendal nerves, which you use to control bowel movements.
Also known as defecography, this test uses an MRI or X-ray videos of your rectum when you poop to show how well it holds and releases feces.
A long tube inserted into your rectum with a tiny camera at the end can show the inside of your intestines and look for any problems that may be causing your prolapse.
This test also uses a long tube with a camera on the end. It’s inserted deep into your intestines to look for inflammation, scarring, or a tumor.
This imaging scan examines all of the organs in your pelvic area.
Lower GI series
Also known as a barium enema, pictures of your lower gastrointestinal tract will be taken with X-rays.
Rectal Prolapse Treatment
If your rectal prolapse is very minor and it is caught early, your doctor might recommend rectal prolapse self-care that includes taking stool softeners to make it easier to go to the bathroom and pushing the rectum’s tissue back up the anus by hand. You may be able to use these solutions for several years without major problems. Sometimes children with rectal prolapse are cured by treating the cause – like chronic diarrhea or constipation. But in adults, the muscles don't repair on their own, and you will eventually need surgery to fix rectal prolapse.
Rectal prolapse surgery is used to put the rectum back in place, and there are several types. The kind of surgery your doctor recommends will depend on things like your overall health, age, and the seriousness of your condition. The two most common types of surgery:
This type of surgery is done through the belly area either with a large cut or using laparoscopy. With laparoscopy, small cuts are made in the belly, and a camera attached to an instrument lets the surgeon see what the problem is and if any other issues need to be fixed. Your surgeon will usually tack your rectum back in place with stitches or mesh. You will have general anesthesia for this procedure, which is needed for more severe cases of rectal prolapse. Rectopexy is successful in treating rectal prolapse in about 97% of cases.
Also called rectal repair, this may be used if you are older, have minor prolapse, or if your rectum is stuck to the skin outside of the body. This surgery can involve the inner lining of the rectum or the portion of the rectum extending out of the anus. With perineal surgery, you may be able to have local anesthesia instead of going completely under. There are two main kinds of perineal surgery:
- In an Altemeier procedure, your doctor removes the prolapsed part of the rectum. The remaining part of your large intestine is your new rectum and is sewn together with the anus. With this procedure, there is the chance the rectum may prolapse again later.
- A Delorme procedure is usually recommended if you have a minor prolapse. Here, the doctor will remove the lining of the rectum, fold the muscle wall back in, and attach it to the anal canal with stitches.
The risks involved with rectal prolapse surgery include:
- Sexual dysfunction
- Bowel obstruction or constipation that gets worse
- Damage to nearby nerves and organs
- Rectal prolapse returning (this happens in about 2%-5% of people who have surgery)
You will spend a short time in the hospital, maybe just overnight. You will drink liquids and then move to solid foods. Your doctor will want to make sure your bowel movements return to normal. To avoid constipation and rectal prolapse return, your doctor will have you drink lots of water, eat plenty of fiber, and use stool softeners. You should be able to return to normal activities 4-6 weeks after surgery.
Rectal Prolapse Prevention
To reduce rectal prolapse, try not to strain when you poop. Things that can also ease or prevent constipation that leads to straining include:
- Increasing your fiber intake by aiming for at least five servings of fruits and veggies each day
- Drinking 6-8 glasses of water a day
- Getting regular exercise
- Keeping your weight at a healthy level or losing weight if you need to
If you have constipation often, talk to your doctor. They may direct you to take a stool softener or laxative. Also, avoid heavy lifting, as this could put pressure on your bowel muscles.
Rectal Prolapse Complications
Rectal prolapse, if it’s not treated, could lead to these complications:
- Rectal damage like ulceration or bleeding
- Becoming unable to manually push your rectum back inside your body
- Strangulation, or the blood supply in your rectum is reduced
- Gangrene, or the strangulated rectal tissue decays and dies
- A harder time holding in gas and poop (This happens in about 50%-75% of people with rectal prolapse.)