Rectal Prolapse

Search Knowledgebase

Topic Contents

Rectal Prolapse

Topic Overview

Illustration of the lower digestive system

What is rectal prolapse?

Rectal prolapse occurs when part or all of the wall of the rectum slides out of place, sometimes sticking out of the anus. See a picture of rectal prolapse.

There are three types of rectal prolapse.

  • Partial prolapse (also called mucosal prolapse). The lining (mucous membrane) of the rectum slides out of place and usually sticks out of the anus. This can happen when you strain to have a bowel movement. The condition may be confused with internal hemorrhoids. (See a picture of a hemorrhoid.) Partial prolapse is most common in children younger than 2 years.
  • Complete prolapse. The entire wall of the rectum slides out of place and usually sticks out of the anus. At first, this may occur only during bowel movements. Eventually, it may occur when you stand or walk. And in some cases the prolapsed tissue may remain outside your body all the time.
  • Internal prolapse (intussusception). One part of the wall of the large intestine (colon) or rectum may slide into or over another part, like the folding parts of a telescope. The rectum does not stick out of the anus. (See a picture of intussusception.) Intussusception is most common in children and rarely affects adults. In children, the cause is usually not known. In adults, it is usually related to another intestinal problem, such as a growth of tissue in the wall of the intestines (such as a polyp or tumour).

In severe cases of rectal prolapse, a section of the large intestine drops from its normal position as the tissues that hold it in place stretch. Typically there is a sharp bend where the rectum begins. With rectal prolapse, this bend and other curves in the rectum may straighten, making it difficult to keep stool from leaking out (fecal incontinence).

Rectal prolapse is most common in children and older adults, especially women.

What causes rectal prolapse?

Many conditions increase the chance of developing rectal prolapse. Risk factors for children include:

  • Cystic fibrosis. A child who has rectal prolapse with no obvious cause may need to be tested for cystic fibrosis.
  • Having had surgery on the anus as an infant.
  • Malnutrition.
  • Deformities or physical development problems.
  • Straining during bowel movements.
  • Infections.

Risk factors for adults include:

  • Straining during bowel movements because of constipation.
  • Tissue damage caused by surgery or childbirth.
  • Structural conditions present since birth.
  • Weakness of pelvic floor muscles that occurs naturally with age.

What are the symptoms?

The first symptoms of rectal prolapse may be:

  • Leakage of stool from the anus (fecal incontinence).
  • Leakage of mucus or blood from the anus (wet anus).

Other symptoms of rectal prolapse include:

  • A feeling of having full bowels and an urgent need to have a bowel movement.
  • Passage of many very small stools.
  • The feeling of not being able to empty the bowels completely.
  • Anal pain, itching, irritation, and bleeding.
  • Bright red tissue that sticks out of the anus.

How is rectal prolapse diagnosed?

Your doctor will diagnose rectal prolapse by asking you questions about your symptoms and past medical problems and surgeries. He or she will also do a physical examination. He or she may do tests to rule out other conditions.

How is it treated?

Prolapse in children tends to go away on its own.

In adults, eating plenty of foods that contain fibre may improve partial (mucosal) prolapse caused by constipation and straining. But surgery is usually needed if you have a complete prolapse or a partial prolapse that does not improve with a change in diet. Surgery involves attaching the rectum to the muscles of the pelvic floor or the lower end of the spine (sacrum). Or surgery might involve removing a section of the large intestine that is no longer supported by the surrounding tissue. Both procedures may be done in the same surgery.

Frequently Asked Questions

Learning about rectal prolapse:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Symptoms

The first sign of rectal prolapse is often the unexpected release of mucus, stool, or blood from the anus.

Other symptoms of rectal prolapse include:

  • A feeling of having full bowels and an urgent need to have a bowel movement.
  • Passage of many very small stools.
  • The feeling of not being able to empty the bowels completely.
  • An inability to control bowel movements (fecal incontinence) that becomes worse over time.
  • Anal pain, itching, irritation, and bleeding.
  • Bright red tissue that protrudes from the anus.

You may notice tissue slipping out of the anus during a bowel movement. As the condition becomes worse, tissue may slide out of the anus when you stand and then may remain outside the anus all the time.

Prolapse of only the lining of the rectum (partial prolapse) can be confused with hemorrhoids. In partial prolapse, rings of red tissue usually protrude out of the anus while you strain during a bowel movement. In hemorrhoids, the tissue that protrudes out of or next to the anus may look like a red or blue lump, and there may be several lumps.

Complications

Rectal prolapse that is not treated can lead to complications.

  • Fecal incontinence may become worse. And permanent damage can occur to the circular muscle that controls the anus (anal sphincter).
  • The rectum can become damaged from the tissues rubbing together, which can result in a sore (ulcer) that may bleed.
  • Normal blood flow to tissue in the rectum may be cut off. This causes the tissue to die (gangrene).
  • If a prolapsed rectum swells, it may prevent the passage of stools.
  • In rare cases, a loop of the large intestine is pinched off (strangulated), causing blockage of the intestine (bowel obstruction).

Other conditions that can cause symptoms similar to those of rectal prolapse include inflammatory bowel disease, irritable bowel syndrome, polyps, and colon or rectal cancer. Complications after surgery for hemorrhoids or a fistula also can cause these symptoms.

Examinations and Tests

A doctor can diagnose rectal prolapse by asking you questions about your symptoms and by doing a physical examination. The doctor may ask questions about when your symptoms began and whether they have changed over time. Your doctor may ask whether you have had:

  • Any bleeding or irritation around your anus.
  • Leakage of mucus or stools that may stain underwear.
  • Any tissue that slips out of your anus and when it occurs.

Also, your doctor may ask about any past surgeries or medical conditions, such as whether you have:

  • Had rectal surgery.
  • Had pelvic surgery, such as the removal of your uterus (hysterectomy).
  • Had a back injury, surgery, or condition such as spina bifida.
  • Given birth, how many times you have given birth, and whether you ever had complications, such as not being able to control your bladder or bowels after delivery (stress incontinence).
  • Diseases such as celiac disease, cystic fibrosis, or inflammatory bowel disease.
  • Used laxatives or enemas regularly or used other products to help with bowel movements.

The physical examination usually includes:

  • Examining the rectum with a gloved finger to feel for loose tissue and to find out how strongly the anal sphincter contracts. You may be asked during the examination to strain as you would during a bowel movement. The doctor may observe the anus while you strain to test the strength of your pelvic muscles and to see whether tissue drops out of your anus.
  • Inspecting the skin around the anus for irritation, which may indicate a discharge of mucus, contact with stools, or excessive cleaning.
  • Testing the sensation around the anus with sharp and dull instruments to determine how well the nerves are working.

Other tests are often done to rule out other conditions that may be contributing to the problem. These tests may include:

  • Anoscopy, sigmoidoscopy, colonoscopy, or a barium enema to look for growths such as tumours, sores (ulcers), or abnormally narrow areas in the large intestine.
  • A fecal occult blood test to look for hidden (occult) blood in the stool.
  • Defecography, which is a series of X-rays (like a motion picture) to evaluate the rectum and anal sphincter during a bowel movement.
  • Anal manometry to measure the strength of the anal sphincter.
  • Electromyography to find out whether there is a problem with the nerves that lead to the anal sphincter.
  • Sweat test for cystic fibrosis in children who have unexplained or recurrent rectal prolapse.

Treatment Overview

See your family doctor or general practitioner if you or your child has symptoms of rectal prolapse. Sometimes home treatment such as eating a high-fibre diet can reverse the prolapse.

If the problem does not go away, you may need further treatment. This may include surgery, especially when the whole rectal wall and not just the lining sticks out of the anus (complete prolapse).

Treatment of children with rectal prolapse

In children, rectal prolapse usually goes away on its own. A parent or other caregiver often can manage the rectal prolapse with home care methods until it heals. If your child has a rectal prolapse, you can help prevent the prolapse from coming back by:

  • Pushing the prolapse back into place as soon as it occurs. Wear disposable latex gloves and use lubricating jelly. Applying an ice pack can help decrease swelling.
  • Having the child use a small toilet that is placed on the floor. This will help support the child's buttocks so that he or she will not have to strain while having a bowel movement.

Most children who develop rectal prolapse between the ages of 9 months and 3 years will respond to home treatment. In these cases, prolapse usually does not continue after age 6.

If a medical condition, such as cystic fibrosis, is causing rectal prolapse, it will usually need to be treated to resolve the prolapse.

If rectal prolapse is not caused by another condition or does not respond to home treatment, your child may need other treatment. Injecting a chemical called a sclerosant into the wall of the rectum can be very effective at treating rectal prolapse in children who do not improve after home treatment.

Treatment of adults with rectal prolapse

Treatments for rectal prolapse in adults focus on changes in diet, medicine (such as stool softeners), and surgery. Treatment choice depends on the type of prolapse, whether you have other physical problems, your age, your activity level, and whether you can do home treatment. Home treatments usually are tried first, because surgery does not always cure the condition.

You may treat a prolapse of the lining (partial prolapse) by changing your diet to reduce constipation and straining during a bowel movement. Adding fibre to your diet increases the amount of water in your stools and helps them move through the large intestine quickly. You may also use a medicine, such as lactulose, that softens stools and allows them to move through the intestines and pass easily.

If you have a partial prolapse that does not improve with a change in diet or other self-care, you may need surgery to secure or remove tissue that slides out of the anus.

If you need surgery, the type of procedure depends on the size of the prolapse and your overall health. This includes any symptoms you have as well as other physical problems that may contribute to the prolapse.

Two types of surgery are used to treat a complete prolapse. A surgeon may operate through the belly to secure part of the large intestine or rectum to the inside of the abdominal cavity (rectopexy). Sometimes the surgeon removes the affected part of intestine. This type of surgery is most often used for younger, physically fit people.

Surgery also can be done through the area between the genitals and the anus (perineum) to strengthen the anal sphincter. This type of surgery is best for people who are elderly or are not physically fit.

Surgery is most often successful for people who still have some control over the anal sphincter. If the sphincter is damaged, surgery may correct the prolapse but not be able to completely correct fecal incontinence. In some cases, fecal incontinence can become worse.

For diagnosis of rectal prolapse and treatment that does not involve surgery, you can see your family doctor or general practitioner or your child's pediatrician. You may be referred to a specialist, such as a gastroenterologist. If you need surgery, you will need to see a general surgeon or a colorectal surgeon.

Home Treatment

Home treatment for children

If your child has a rectal prolapse, you can help prevent the prolapse from coming back.

  • Push the prolapse back into place as soon as it occurs. Wear disposable latex gloves and use lubricating jelly. Apply an ice pack to help decrease swelling.
  • Have the child use a small toilet that is placed on the floor. This will help support the child's buttocks so that he or she will not have to strain while having a bowel movement.

Home treatment for adults

Protruding tissue caused by rectal prolapse often can be pushed back into place. Stand with your chest tucked as closely to your thighs as you can. Using a wet, gloved finger or a soft, warm, wet cloth, gently reinsert any tissue that comes out of the anus. If the rectal tissue cannot be inserted easily into the anus, see your doctor.

Other measures you can take at home that can help rectal prolapse include the following:

  • Drink plenty of water. And eat fruits, vegetables, and other foods that contain fibre. A high-fibre diet can help prevent constipation and reduce the need to strain during a bowel movement. Changes in diet often are enough to improve or reverse a prolapse of the lining of the rectum (partial prolapse), which does not always protrude from the anus.
  • Do Kegel exercises to help strengthen the muscles of the pelvic area. Although these exercises usually are used to help prevent urinary incontinence and prolapse of the uterus, they also can strengthen muscles in the pelvic area and may improve symptoms of rectal prolapse in both men and women.
  • Do not strain while having a bowel movement.
  • Use stool softeners to prevent straining. Stool softeners include lubricants, such as docusate (for example, Colace), and fibre supplements, such as psyllium (for example, Metamucil).
  • Sometimes you may need to use a laxative or an enema if diet alone will not relieve constipation.

Other Places To Get Help

Organization

American Society of Colon and Rectal Surgeons
85 West Algonquin Road
Suite 550
Arlington Heights, IL  60005
Phone: (847) 290-9184
Fax: (847) 290-9203
Email: ascrs@fascrs.org
Web Address: www.fascrs.org
 

The American Society of Colon and Rectal Surgeons is the leading professional society representing more than 1,000 board-certified colon and rectal surgeons and other surgeons dedicated to treating people with diseases and disorders affecting the colon, rectum, and anus.


References

Other Works Consulted

  • Patel SM, Lembo AJ (2006). Rectal prolapse and solitary rectal ulcer syndrome section of Constipation. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 1, pp. 230–231. Philadelphia: Saunders Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer C. Dale Mercer, MD, FRCSC, FACS - General Surgery
Last Revised February 17, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.