Rectal Prolapse

Rectal prolapse is an uncommon condition in which the rectum—the lower part of the large intestine—drops down through the anus. 

In complete rectal prolapse, the entire wall of the rectum drops through the anus. In partial rectal prolapse, only the lining of the rectum drops through the anus.

Among adults, rectal prolapse occurs more often in people over age 50 and is more common in women than men. It is rare in children and usually affects those younger than age 4.

Problems Associated with Rectal Prolapse

Women with rectal prolapse may also have weak pelvic floor muscles, which can lead to other problems, such as:

• Enterocele (hernia of the intestines)
• Rectocele (bulging of the rectum into the vagina)
• Cystocele (bulging or dropping of the bladder into the vagina)
• Uterine or vaginal prolapse (dropping of the uterus or vagina out of normal position)

Complications

The possible complications of rectal prolapse may include:

• Rectal ulcers, which may cause bleeding
• Rectal prolapse that cannot be pushed back inside (a medical emergency because it can cut off blood supply to the rectum)
• Damage to the anal sphincter muscles or nerves, leading to or worsening fecal incontinence (bowel control problems)

Symptoms

• The symptoms of rectal prolapse may include:
• A reddish-colored mass protruding from the anus
• Constipation, diarrhea, or both
• Feeling of incomplete bowel movements
• Passing blood or mucus from the rectum
• Fecal incontinence

Without treatment, constipation and bowel control problems may get worse, and the rectum may drop through the anus more often and more easily. Over time, it may not go back inside on its own and may need to be pushed back manually.
 

Seek medical care right away if you have heavy bleeding or a prolapse that cannot be pushed back inside the body.

Causes and Risk Factors

The exact cause of rectal prolapse is unknown, but certain structural defects and risk factors increase the likelihood of developing the condition.

Structural defects
In adults with rectal prolapse, doctors often find:

• A rectum that moves more than normal instead of staying fixed in place
• Weak pelvic floor muscles
• Weak anal sphincters

In children, the rectum may lack its usual curve and be positioned straight and vertical, which may increase risk.

Risk factors
Conditions that raise abdominal pressure or weaken pelvic floor muscles can increase the risk of rectal prolapse. These include:

• Chronic constipation or straining during bowel movements
• Chronic diarrhea
• Cystic fibrosis
• Nerve or muscle disorders affecting the pelvic floor
• Intestinal infections with certain parasites
• Pelvic surgery
• Whooping cough
• Diagnosis
  Diagnosis involves a medical history, symptom review, and physical exam. During a physical exam, your doctor will examine the anus to determine whether the prolapse is partial or complete. You may be asked to strain as if having a bowel movement to see the prolapse. Your doctor may also do a digital rectal exam.
   

In addition, your doctor may order tests to confirm the diagnosis or check for other conditions. These tests may include:

• Defecography: X-rays or MRI video showing how the rectum holds and empties stool and identifying structural changes
• Colonoscopy: A flexible tube with a light and camera examines the rectum and colon
• Lower GI series: X-rays using a chalky barium liquid to view the large intestine
• Anorectal manometry: Measures how well rectal and anal nerves and muscles function

Treatment Options

Treatment for rectal prolapse will depends on your age, symptoms, and the cause of the condition.

In adults, surgery is the most common treatment. Even after surgery, rectal prolapse can return. Preventing constipation helps reduce the risk of recurrence.

For children with rectal prolapse, doctors treat the underlying cause first, such as constipation or diarrhea. If this does not resolve the problem, surgery may be considered.