What is rectal prolapse?

Rectal prolapse occurs when the rectum (the last section of the large intestine) falls from its normal position within the pelvic area. (The word "prolapse" means a falling down or slipping of a body part from its usual position.)

The term "rectal prolapse" can describe three types of prolapse:

  • The entire rectum extends out of the anus
  • Only a portion of the rectal lining is pushed through the anus
  • The rectum starts to drop down but does not extend out the anus (internal prolapse)

Rectal prolapse is common in older adults with a long-term history of constipation or a weakness in the pelvic floor muscles. It is more common in women than in men and even more common in women over the age of 50 (postmenopausal women) but occurs in younger people too. Rectal prolapse can also occur in infants – which could be a sign of cystic fibrosis – and in older children.

Is rectal prolapse just another name for hemorrhoids?

No. Rectal prolapse results from a sagging of the last portion of the large intestine. Hemorrhoids are swollen blood vessels that develop in the anus and lower rectum. Hemorrhoids can produce anal itching and pain, discomfort, and bright red blood on toilet tissue. Early rectal prolapse can mimic internal hemorrhoids that have slipped out of the anus (ie, prolapsed), making it difficult to tell these two conditions apart.

What are the symptoms of rectal prolapse?

The symptoms of rectal prolapse include the feeling of a bulge or the appearance of reddish-colored mass that extends outside the anus. At first, this can occur during or after bowel movements and is a temporary condition. However, over time – due to an ordinary amount of standing and walking – the end of the rectum may extend out of the anal canal and needs to be pushed back up into the anus by hand.

Other symptoms of rectal prolapse include pain in the anus and rectum and rectal bleeding from the inner lining of the rectum. These are rarely life threatening symptoms. Fecal incontinence is another symptom. Fecal incontinence refers to leakage of mucus, blood or stool from the anus. This occurs as a result of the rectum stretching the anal muscle. Symptoms change as the rectal prolapse itself progresses.

What causes rectal prolapse?

Rectal prolapse can occur as a result of many conditions, including:

  • Chronic constipation or chronic diarrhea
  • Long-term history of straining during bowel movements
  • Older age: Muscles and ligaments in the rectum and anus naturally weaken with age. Other nearby structures in the pelvis area also loosen with age, which adds to the general weakness in that area of the body.
  • Weakening of the anal sphincter: This is the specific muscle that controls the release of stool from the rectum.
  • Prior injury to the anal or pelvic areas
  • Damage to nerves: If the nerves that control the ability of the rectum and anus muscles to contract are damaged, rectal prolapse can result. Nerve damage can be caused by pregnancy, difficult vaginal childbirth, anal sphincter paralysis, spinal injury, back injury/back surgery, and/or other surgeries of the pelvic area.
  • Other diseases, conditions, and infections: Rectal prolapse can be a consequence of diabetes, cystic fibrosis, chronic obstructive pulmonary disease, hysterectomy, and infections in the intestines caused by parasites – such as pinworms and whipworms – and diseases resulting from poor nutrition or from difficulty digesting foods.