The condition occurs when the supporting structures that normally hold the rectum in place weaken, allowing it to telescope down and out. It is most common in older adults, particularly women, and is often linked to a long history of straining and to changes in the pelvic floor over time.

What causes rectal prolapse?

Rectal prolapse develops when the muscles and ligaments that support the rectum become weak or stretched. Several factors contribute: long-standing constipation and straining, weakening of the pelvic floor with age and after childbirth, and conditions that increase pressure in the abdomen. Because these factors build up over years, the prolapse tends to appear gradually and worsen over time if untreated.

How rectal prolapse presents

The hallmark is a sensation, and often the sight, of tissue protruding from the anus, especially during a bowel movement. Early on it may reduce by itself; later it may need to be pushed back; eventually it can remain out. Other common symptoms include:

• A feeling of a bulge or something coming down, particularly on straining
• Mucus discharge or bleeding from the exposed tissue
• A sensation of incomplete emptying after a bowel movement
• Difficulty controlling bowel movements, or conversely, constipation

The impact on continence and on daily confidence can be considerable, and it is a legitimate part of the condition rather than something to downplay.

Rectal prolapse versus hemorrhoids: a crucial distinction

This is the confusion that delays many diagnoses. Prolapsing hemorrhoids can also protrude through the anus, and the two are easily mistaken for one another, yet they are different conditions needing different treatment. The key distinction lies in what is protruding: a full-thickness rectal prolapse involves the whole wall of the rectum, often appearing as concentric rings of tissue, while prolapsing hemorrhoids are cushions of vascular tissue with a different appearance. Getting this distinction right is essential, because treating a rectal prolapse as if it were hemorrhoids will not work. A surgeon experienced in anorectal disease tells them apart on examination.

Types of rectal prolapse

Clinicians distinguish a few patterns. A full-thickness external prolapse, where the entire rectal wall protrudes through the anus, is the classic and most apparent form. There are also internal forms, where the rectum telescopes within itself without fully emerging, which can cause symptoms of obstructed emptying. The type influences the assessment and the choice of operation.

How rectal prolapse is diagnosed

Diagnosis is made by a surgeon on examination, sometimes asking the patient to strain so the prolapse can be seen as it would occur naturally. Further assessment of pelvic floor function may be arranged to plan treatment and to address related issues such as continence. A thorough evaluation matters because the prolapse often coexists with other pelvic floor problems that are best addressed together.

Treatment: why surgery is the answer

The key message is that rectal prolapse is corrected surgically. Conservative measures such as managing constipation and pelvic floor exercises have a supporting role and may help symptoms, but they do not fix the underlying descent of the rectum, so surgery is the definitive treatment. The good news is that effective, well-established operations exist, and the approach is chosen to fit the individual.

The surgical approaches

Broadly, operations for rectal prolapse take one of two routes:

• An abdominal approach, in which the rectum is lifted and secured in its proper position, often using a technique that fixes it to the back of the pelvis. This is durable and frequently chosen for fitter patients.
• A perineal approach, performed through the area around the anus without an abdominal operation, which can be well suited to older or frailer patients or particular situations.

The choice between them depends on the type of prolapse, the patient’s overall health and other pelvic floor factors. A surgeon will explain which approach fits best and why, and what recovery to expect, which varies with the operation chosen.

Why treatment should not be delayed

An untreated prolapse tends to worsen, with the protrusion becoming more frequent and continence often deteriorating over time. Treating it earlier generally means a more straightforward operation and a better functional result. If you notice tissue protruding from the anus, particularly if it is recurring, it is worth being assessed rather than living with it.

When to see a doctor

See a surgeon if you notice tissue protruding from the anus, a persistent sense of something coming down, or new problems with bowel control. Because the condition is easily confused with hemorrhoids, a proper assessment is the way to get the right diagnosis and the right treatment.