Rectal prolapse means the rectum slipping out through the anus. Learn the forms, symptoms, causes and treatment options, from banding and laser to surgical repair.
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Quick answer: rectal prolapse is the rectum slipping down and turning outward through the anus. It does not settle on its own and tends to progress. What the treatment looks like depends on which layer of the bowel comes out: mucosal prolapse can usually be handled with banding or laser, while full-thickness prolapse needs a repair procedure. A prolapse that stays outside and swells is an emergency.
Medically reviewed by Op. Dr. Yasir Gözü, Proctology.
The rectum is the last 12 to 15 centimetres of the large bowel. It is held in place by ligaments, by the pelvic floor muscles and by the sphincter complex that surrounds the anal canal. When that support loosens, the rectum can slide downward and telescope out through the anus. That is rectal prolapse.
At the start it usually appears only during a bowel movement and slips back by itself. Over months or years it comes out more easily — while walking, coughing or standing — and eventually stays outside. As it protrudes more often, the sphincter is stretched, which is why leakage and soiling become part of the picture in a large share of patients.
The condition is most common in two very different groups: women over fifty, particularly after several vaginal deliveries, and small children between one and four years of age. In children it is almost always temporary and settles once constipation or the underlying cause is corrected.
Not every prolapse is the same, and the difference matters because it decides the treatment. Only the inner lining may descend, the bowel may fold into itself without ever appearing outside, or the entire wall may come out.
Form | What is seen | Usual approach |
|---|---|---|
Mucosal (partial) prolapse | Only the lining slips out, usually 1-3 cm; radial folds; often mistaken for haemorrhoids. | Bowel regulation, rubber band ligation or laser. |
Internal intussusception | The rectum folds into itself but nothing appears outside; a persistent feeling of incomplete emptying. | Pelvic floor exercises, biofeedback, treating constipation. |
Full-thickness (complete) prolapse | The whole bowel wall comes out in concentric rings, 3-10 cm or more. | A repair operation is usually needed. |
Irreducible or strangulated prolapse | Stays outside, swells and becomes painful; the blood supply is at risk. | Emergency — same-day assessment. |
The first thing most people notice is a soft, moist bulge after straining. Beyond that, the complaints tend to build up gradually:
The two are confused constantly, and the distinction is visible. Prolapsed rectum comes out as a single tube with rings running around it, like the layers of a telescope. Prolapsed haemorrhoids come out as separate lumps with grooves running outward from the centre. Prolapse is also usually painless until it becomes trapped, while thrombosed haemorrhoids hurt sharply. If there is any doubt, an examination settles it in minutes.
Rectal prolapse is rarely traced to a single cause. It develops when long-term pressure meets weakened support.
Diagnosis usually takes one visit. The prolapse is often not visible when a patient lies on the examination couch, so we ask the patient to strain, or to squat, so that the descent can be seen and measured. Feeling the sphincter tone during the same examination tells us how much reserve is left.
Anoscopy shows the anal canal and separates prolapse from haemorrhoids and polyps. Where the prolapse never comes outside, or where symptoms do not fit what is visible, imaging is added: defecography — by X-ray or MRI — shows the rectum folding into itself during evacuation. Anorectal manometry measures sphincter pressure when incontinence is a major complaint, and endoanal ultrasound shows a sphincter that has been damaged by childbirth.
Colonoscopy is recommended in adults, particularly over fifty, to make sure a polyp or tumour is not acting as the leading point of the prolapse.
For mucosal prolapse, internal intussusception and early disease, the first step is to remove the strain. That means 25 to 30 grams of fibre a day, enough fluid, stool softeners where needed, and a firm rule against sitting and pushing on the toilet. Pelvic floor exercises and biofeedback help patients who cannot coordinate the muscles during evacuation — a common finding in internal intussusception. These measures rarely reverse a full-thickness prolapse, but they slow it and they make any later procedure easier.
Mucosal prolapse can be treated the same way as advanced internal haemorrhoids: rubber band ligation of the redundant lining, or laser treatment that shrinks and fixes the tissue in place. Both are done under local anaesthesia, take a short session, and allow the patient to go home the same day. In children, prolapse almost always resolves once constipation or diarrhoea is treated; injection sclerotherapy is used in the few who continue to prolapse.
When the entire bowel wall comes out, the rectum has to be fixed back to the sacrum or the redundant segment removed. Abdominal procedures — most often laparoscopic ventral mesh rectopexy — have the lowest recurrence rates and are preferred in patients fit for a general anaesthetic. Perineal operations such as the Delorme and Altemeier procedures are done through the anus, avoid an abdominal incision and are chosen for elderly or frail patients, at the price of a higher chance of recurrence. Which one suits a particular patient depends on age, general health, sphincter function and how much bowel is involved.
A prolapse that will not go back swells within hours, and the swelling then makes reduction harder still. If the blood supply is cut off the tissue can die. Anyone whose prolapse stays outside, darkens or becomes painful should be seen the same day rather than waiting for a routine appointment.
Rectal prolapse does not stabilise. The segment that comes out grows longer, the sphincter is stretched further, and incontinence that started as occasional staining becomes constant. The exposed lining ulcerates and bleeds, and chronic mucus keeps the skin around the anus raw. The longer the sphincter has been stretched, the less continence returns after repair — which is the practical argument for treating it early rather than living with it.
After banding or laser treatment of mucosal prolapse, most patients are back to daily life the next day, with mild discomfort for a few days and a follow-up check to confirm healing. After surgical repair, recovery ranges from about two weeks for a perineal procedure to four to six weeks after an abdominal one. In every case the same rule applies afterwards: the bowel habit that caused the prolapse has to change, or the problem returns.
Book an examination if tissue appears at the anus after a bowel movement, if you have started leaking gas or stool, or if mucus and staining have become a daily problem. Go the same day if the prolapse cannot be pushed back, becomes painful, or changes colour.
Disclaimer: This content is for general information only and is not a substitute for professional medical advice, diagnosis, or treatment. Please consult a physician for guidance specific to your condition.
