What Is Rectal Prolapse?

Rectal prolapse occurs when the final portion of the large intestine (rectum) slips out of its normal position and protrudes through the anus, similar to a telescope folding out of itself.
Under normal conditions, the rectum is held in place by connective tissues and ligaments that anchor it to surrounding organs. When these supporting structures weaken or become damaged, the rectum may descend and protrude externally.

This condition is most common in women over 50 years of age and is about six times more frequent in women than in men. It can be a source of embarrassment for patients and significantly affect quality of life. While not always requiring surgery, the most effective treatment is typically surgical correction.

Causes

Although several contributing factors have been identified, there is no single definitive cause of rectal prolapse.
Among affected individuals:

  • 30–65% have a history of chronic constipation,

  • 15% experience chronic diarrhea.

While rectal prolapse was once strongly linked to multiple vaginal births, 35% of female patients have never given birth, and the condition can also occur in men.

Symptoms

A common question is whether rectal prolapse and hemorrhoids are the same. Although both may present with rectal bleeding and protruding tissue, they are different conditions:

  • In rectal prolapse, an entire segment of the rectal wall slides out through the anus.

  • In hemorrhoids, the issue arises from swollen blood vessels near the anal opening.

Over time, rectal prolapse can cause weakening of the anal sphincter, leading to fecal incontinence (loss of bowel control).

Diagnosis

Diagnosis is made by directly observing the prolapsed rectum during examination.
The physician may ask the patient to sit and strain as if having a bowel movement to make the prolapse visible.

Additional diagnostic tests include:

  • Videodefecography: An X-ray imaging study performed while the patient simulates defecation to assess the movement of the rectum and pelvic floor muscles.

  • Anorectal manometry: Measures the strength and reflexes of the anal sphincter muscles to evaluate function.

Treatment

Although chronic constipation and excessive straining contribute to rectal prolapse, correcting these alone is rarely sufficient once prolapse has occurred.
Several surgical techniques are available, including:

  • Resection: Removing a portion of the colon and reconnecting the ends (resection and anastomosis).

  • Rectopexy: Lifting and securing the rectum back into its normal position inside the pelvis, either by sutures or by using a synthetic mesh for reinforcement.

The surgical approach (abdominal or perineal) depends on the patient’s condition, age, and overall health.

Postoperative Recovery

Most patients experience significant improvement in symptoms after surgery.
If rectal prolapse has caused weakening of the anal muscles, they may gradually regain strength after the prolapse is corrected.

Factors influencing surgical outcomes include:

  • The preoperative condition of the anal sphincter muscles

  • Whether the prolapse was internal or external

  • The patient’s overall health status

Full assessment of bowel function after surgery may take up to one year.
To maintain surgical success and prevent recurrence, patients should avoid chronic constipation and straining.