Yes, men can have prolapse. While pelvic organ prolapse is far more common in women, men can experience rectal prolapse (where the rectum drops or pushes through the anus) and, less commonly, bladder prolapse. Rectal prolapse affects about 0.5% of the general population, and though women account for the majority of cases, men develop it too, particularly after age 50.
What Prolapse Looks Like in Men
In women, prolapse often involves the uterus, bladder, or vaginal walls shifting downward due to weakened pelvic support. Men don’t have those structures, so the conversation centers on the rectum and, to a lesser extent, the bladder. Rectal prolapse happens when the rectum loses its normal attachments to the pelvis and slides downward, sometimes protruding through the anus.
There are three stages. Internal prolapse means the rectum has started to fold in on itself and drop, but hasn’t emerged from the body. Mucosal prolapse involves only the inner lining of the rectum poking through the anus. Full-thickness (external) prolapse is when the entire wall of the rectum pushes out. Each stage comes with progressively worse symptoms, and an internal prolapse can silently worsen over months or years before becoming visible.
Common Symptoms
The earliest sign is often a feeling of pressure or fullness in the anus, especially during or after a bowel movement. You might feel like you haven’t fully emptied your bowels even when you have. As the prolapse progresses, you may notice a soft, reddish mass protruding from the anus, particularly after straining on the toilet or standing for long periods. In early stages it retracts on its own; later it may need to be pushed back in manually.
Other symptoms include leakage of mucus, blood, or stool from the anus, along with itching or discomfort. Between 50% and 75% of people with rectal prolapse report some degree of fecal incontinence, because the anal sphincter muscles get progressively stretched out as the condition worsens.
Causes and Risk Factors
Chronic constipation and straining are the most significant modifiable risk factors. Somewhere between 50% and 75% of people with rectal prolapse also report difficulty with evacuation. The straining weakens the attachments that anchor the rectum to the sacrum (the bony back wall of the pelvis), and once those attachments stretch, the rectum can begin to slide. The relationship goes both directions: constipation contributes to prolapse, and prolapse makes constipation worse by creating a kink or fold in the rectum that traps stool.
Other factors include weakened pelvic floor muscles, nerve damage (particularly to the pudendal nerve, which controls the muscles around the anus), chronic diarrhea, and a history of pelvic surgery. Age plays a major role, with incidence climbing after the fifth decade of life. The condition is also seen more frequently in people with neurological or psychiatric conditions that affect bowel habits or physical activity levels.
Prolapse vs. Hemorrhoids
One of the most common points of confusion is the difference between a rectal prolapse and prolapsed internal hemorrhoids. Both can produce a mass protruding from the anus, and both cause discomfort, bleeding, and mucus discharge. But the treatments are completely different, so distinguishing them matters.
The key difference is the pattern of the tissue folds. Hemorrhoids are swollen blood vessel cushions that protrude in separate columns, creating folds that run in a radial pattern (like spokes on a wheel). A true rectal prolapse involves the full circumference of the rectal wall telescoping outward, producing circular, concentric folds. This distinction is usually visible on a clinical exam, but if you’re unsure what you’re dealing with, a proper evaluation is the only way to tell.
How It’s Diagnosed
Diagnosis typically starts with a digital rectal exam, where a clinician checks sphincter strength and feels for abnormalities. You’ll likely be asked to bear down as if having a bowel movement so the prolapse can be observed directly. If the prolapse only happens intermittently, it might not be visible during an office visit, which is where imaging comes in.
Defecography is the most useful specialized test. It involves placing a contrast dye into the rectum and then taking X-ray or MRI images while you simulate a bowel movement. This reveals the anatomy in motion: how far the rectum drops, whether the pelvic floor muscles coordinate properly, and whether there are structural changes in the surrounding tissues. Anal manometry, a test that measures the pressure and function of the anal sphincter, can provide additional information about muscle strength and nerve function. A colonoscopy may also be ordered to rule out other conditions like polyps or colorectal cancer.
Non-Surgical Management
For mild or early-stage prolapse, or for men who aren’t good candidates for surgery, conservative management focuses on removing the forces that worsen the problem. That means treating constipation aggressively with dietary fiber, adequate hydration, and sometimes stool softeners to eliminate straining. Avoiding prolonged sitting on the toilet and learning not to push forcefully during bowel movements are simple changes that can slow progression.
Pelvic floor physical therapy, including biofeedback, can strengthen the muscles that support the rectum and anus. During biofeedback sessions, a trained physiotherapist teaches you to identify and contract pelvic floor muscles, improve coordination during bowel movements, and build anal sphincter strength. This therapy can be used on its own for small prolapses or as a complement to surgery, where it reduces the chance of the prolapse returning afterward.
Surgical Options
Surgery is the definitive treatment for rectal prolapse that causes significant symptoms or continues to worsen. There are two main approaches, and the choice depends on your overall health, age, and the severity of the prolapse.
The abdominal approach (rectopexy) involves making an incision in the abdomen, pulling the rectum back into its correct position, and anchoring it to the sacrum with sutures or a mesh sling. This is generally considered the more durable repair. Many of these procedures are now done laparoscopically, which means smaller incisions and shorter recovery.
The perineal approach accesses the prolapse through the anus itself, avoiding abdominal surgery entirely. The Altemeier procedure, the more common version, removes the prolapsed segment of rectum through the anus. The Delorme procedure is a variation that removes only the inner lining and tightens the remaining muscle. Perineal procedures tend to be chosen for older patients, those with significant medical problems, or in emergencies where the prolapse has become incarcerated (stuck outside the body and losing blood supply).
Recurrence rates after surgery are low, ranging from about 2% to 5%. The perineal approach carries a slightly higher recurrence risk compared to abdominal repair. Recovery time varies, but most people return to normal activity within a few weeks for perineal procedures and somewhat longer for abdominal surgery.
What Happens if It’s Left Untreated
Delaying treatment increases the risk of permanent damage. The anal sphincter muscles stretch further each time the rectum prolapses, and the nerves that control continence can sustain lasting injury. Over time, this makes fecal incontinence harder to reverse even after surgical repair. Patients with decreased sphincter pressure and slowed nerve conduction before surgery tend to have worse continence outcomes afterward.
In rare cases, the prolapsed tissue can become trapped outside the body and its blood supply can be cut off. This is a surgical emergency. Signs include severe pain, swelling, and darkening of the protruding tissue. If the tissue begins to die, emergency surgery is needed to prevent further complications.