Rectal Prolapse
When the rectum slides out through the anus. More common in older women and in patients with chronic constipation. Surgery is usually the definitive treatment.
Category
Common
Red flags
2
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Rectal prolapse is when the rectum (the last part of the large intestine) loses its normal attachments and slides down and out through the anus. It can be partial (mucosa only) or full-thickness. Different from hemorrhoids — prolapse involves the entire bowel wall.
How common is it?
Most common in women over 50, especially with history of multiple childbirths or chronic constipation. Less common in younger people.
Why does it happen?
Weakened pelvic floor muscles + chronic straining over years. Risk factors: multiple vaginal deliveries, chronic constipation, chronic cough, pelvic surgery, neurological conditions, connective tissue disorders.
Symptoms
- A reddish-pink bulge coming out of the anus during bowel movements
- Initially returns on its own; later requires manual replacement
- Eventually may stay out continuously
- Mucus or stool leakage
- Sensation of incomplete emptying
- Constipation or fecal incontinence (often coexist)
- Bleeding from rectal mucosa
Red flags — seek urgent medical care
Prolapse that cannot be replaced
Risk of strangulation — emergency surgical assessment.
Severe pain or bleeding
Investigate for incarceration or other problem.
How is it diagnosed?
Often visible on exam, especially when the patient strains. Defecography (special X-ray or MRI) confirms diagnosis and assesses pelvic floor anatomy. Anorectal manometry to assess sphincter function. Colonoscopy to rule out other causes.
Outlook — what to expect
Conservative treatment helps mild cases. Surgery is curative for most patients with significant prolapse — multiple approaches available, results generally good.
Treatment
Habits & Lifestyle
Prevent worsening and prepare for surgery.
- Avoid straining — use stool softeners.
- Use a footstool on the toilet.
- Pelvic floor exercises (Kegels) for mild prolapse.
- Treat chronic cough.
- Maintain healthy weight.
Diet
Diet prevents straining.
- High-fiber diet (25-30 g/day).
- 1.5-2 liters of water daily.
- Add psyllium for stool consistency.
Medications
Medications support symptoms.
- PEG (Movicol) to prevent straining.
- Loperamide if also incontinent with loose stool.
Procedures & Surgery
Surgery is the definitive treatment for significant prolapse.
- Abdominal approaches (laparoscopic ventral mesh rectopexy) — best long-term results.
- Perineal approaches (Altemeier or Delorme procedures) — for elderly or unfit patients.
- Biofeedback therapy as adjunct for associated constipation or incontinence.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Which surgical approach is best for me?
- Will I still have constipation or incontinence after surgery?
- What is the risk of recurrence?
Medically reviewed by: SGA Patient Education Panel · Last reviewed 24/04/2026