Rectal Prolapse: Causes, Symptoms, and Treatment

Rectal prolapse happens when the rectum slips out of its normal position and protrudes through the anus. It can range from a minor internal slippage to a more visible, complete prolapse — and while it can be distressing, it's a well-understood condition with effective surgical solutions.

What Is Rectal Prolapse?

Rectal prolapse is a condition in which the rectum — the final section of the large intestine, just above the anus — loses its normal internal support and slips downward, sometimes protruding out through the anal opening. It ranges from a mild internal prolapse (where the rectal wall folds in on itself but doesn't come out) to a full-thickness prolapse, where the entire rectal wall protrudes visibly outside the body, particularly during or after a bowel movement.

What Causes Rectal Prolapse?

• Weakening of the pelvic floor and supporting ligaments, often related to aging
• Chronic straining from long-term constipation
• Multiple vaginal childbirths, which can weaken pelvic support structures over time
• Chronic diarrhea, which can also stress the supporting tissues
• Previous pelvic or rectal surgery
• Neurological conditions affecting the muscles and nerves that support the rectum
• In children, it can occasionally occur with conditions like cystic fibrosis or severe constipation, and often resolves as the underlying cause is treated

The rectum is the final stretch of the large intestine, just above the anus

Signs and Symptoms

• A visible bulge or mass protruding from the anus, especially during or after passing stool
• A sensation of something "falling out" or incomplete emptying
• Mucus or blood-tinged discharge from the rectum
• Fecal incontinence or difficulty controlling gas, in more advanced cases
• Constipation or a feeling of pressure in the pelvis
• Irritation or bleeding of the exposed rectal tissue

How Rectal Prolapse Is Treated

1. Conservative measures first. For mild or early prolapse, treating underlying constipation with a high-fiber diet, adequate fluids, and avoiding excessive straining can sometimes prevent progression, though it rarely fully resolves an established prolapse in adults.
2. Surgical repair — abdominal approach. A common and durable option is rectopexy, in which the rectum is repositioned and secured (often with sutures or mesh) to the sacrum at the back of the pelvis. This can be performed through open, laparoscopic, or robotic surgery, with minimally invasive approaches generally offering a faster recovery.
3. Surgical repair — perineal approach. For older patients or those who aren't good candidates for abdominal surgery, procedures performed through the perineum (such as the Altemeier or Delorme procedures) remove or fold the redundant prolapsed section of the rectum from below, without entering the abdomen.
4. Choosing the right approach. The decision between techniques depends on the patient's age, overall health, extent of prolapse, and surgeon's assessment of what will give the most durable, lowest-risk result.

Recovery

• Hospital stay: Recovery time varies by technique — minimally invasive abdominal repairs often involve a shorter hospital stay than perineal procedures or open surgery.
• Bowel management: A high-fiber diet and stool softeners are typically continued after surgery to minimize straining during healing.
• Activity: Heavy lifting and strenuous activity are usually restricted for several weeks.
• Full recovery: Most people return to normal activity within four to six weeks, depending on the approach used.

Risks and Considerations

• Recurrence, which varies by surgical technique and patient factors
• Bleeding or infection
• Ongoing bowel function issues (constipation or incontinence) that may persist even after successful repositioning, especially if nerve or muscle damage was already present
• General surgical and anesthesia risks, particularly relevant when choosing between abdominal and perineal approaches in older patients

Rectal prolapse occurs when the rectal wall loses its normal support and slips downward

The Takeaway

Rectal prolapse can feel alarming when it's first noticed, but it's a well-recognized condition with several effective surgical options tailored to a patient's age and health status. If you notice tissue protruding from the anus, especially with straining, it's important to see a colorectal specialist rather than wait — early evaluation gives you the most treatment options and the best chance at a lasting repair.