A prolapsed rectum, where rectal tissue slides out through the anus, is treatable at every stage, from simple at-home steps for mild cases to surgery for tissue that prolapses repeatedly. The right approach depends on how much tissue is involved, how often it happens, and whether the tissue can be pushed back in. Most people with a full-thickness prolapse will eventually need surgery, but conservative measures can manage symptoms and sometimes prevent things from getting worse.
What Rectal Prolapse Looks Like
Rectal prolapse is a bulge of tissue coming through the anal opening, most often during or after a bowel movement. One key visual detail: rectal prolapse produces circular folds of tissue, like concentric rings. This distinguishes it from prolapsed hemorrhoids, which have radial folds that fan outward like spokes on a wheel. The distinction matters because the treatments are different.
There are three types. A partial (mucosal) prolapse involves only the inner lining slipping out, usually just an inch or two. A full-thickness prolapse means the entire rectal wall telescopes through the anus. An internal prolapse (intussusception) is when the rectum folds inward but hasn’t come through the opening yet. You may feel a sensation of incomplete emptying, mucus discharge, or difficulty controlling bowel movements.
Why It Happens
Rectal prolapse develops when the muscles and ligaments holding the rectum in place weaken. The most common contributors are chronic constipation and years of straining during bowel movements. Repeated heavy lifting, a long-lasting cough, and being overweight all increase pressure on the pelvic floor. Childbirth, especially deliveries involving tearing or forceps, is another significant factor. Some people have anatomical features that make prolapse more likely, such as a deeper pelvic cavity or a longer-than-usual sigmoid colon. The condition is most common in women over 50, though it can happen to anyone.
Reducing a Prolapse at Home
If tissue has come out and it’s soft, pink, and not severely painful, you can often push it back in yourself. Lie on your side or get into a position where your hips are elevated. Apply gentle, steady pressure with a warm, wet cloth. Push the tissue slowly back through the anal opening. It helps to be relaxed, since tensing your muscles works against you.
When the tissue is swollen and won’t go back in easily, applying ordinary table sugar directly onto the exposed tissue can help. The sugar draws fluid out of the swollen tissue through osmosis, shrinking it enough to allow manual reduction. In documented cases, pouring fine granulated sugar over the prolapsed tissue and waiting about ten minutes reduced the swelling enough that the tissue could then be gently pushed back in. This same technique has been used successfully for prolapsed stomas. It’s a temporary measure, not a cure, but it can get you through an acute episode.
If the tissue is dark red, purple, or black, or if you’re experiencing severe pain, this signals that blood supply may be cut off. This is a strangulated prolapse, and it requires emergency treatment. Don’t attempt to push back tissue that looks discolored or feels hard.
Managing Symptoms Without Surgery
For mild or early-stage prolapse, the first goal is eliminating the straining that makes it worse. That starts with fiber. Gradually increasing your daily fiber intake to around 28 grams, the amount recommended by the National Academy of Sciences, reliably improves constipation and its associated symptoms. You can reach this through high-fiber cereals, fruits, vegetables, and legumes. Pair this with increased water intake, since fiber without enough fluid can make constipation worse.
Stool softeners help if dietary changes alone aren’t enough. The goal is soft, easy-to-pass stools that don’t require pushing. Avoid sitting on the toilet for extended periods, and don’t delay going when you feel the urge, since waiting leads to harder stools and more straining.
Pelvic floor exercises (Kegels) can strengthen the muscles around the rectum and may help with mild cases, particularly when prolapse is internal. However, biofeedback therapy, which uses sensors to help you retrain pelvic floor muscles, has not shown strong evidence of benefit specifically for rectal prolapse or rectal intussusception. It works better for a different problem called dyssynergic defecation, where the muscles contract when they should relax.
When Surgery Becomes Necessary
If the rectum prolapses repeatedly, causes fecal incontinence, or doesn’t stay reduced, surgery is the standard treatment. There are two broad categories: abdominal procedures (through the belly) and perineal procedures (through the area around the anus). The choice depends largely on your overall health and ability to tolerate general anesthesia.
Abdominal Rectopexy
This is the most common approach for otherwise healthy patients. The surgeon lifts the rectum back into its normal position and secures it, often using a small piece of mesh. Modern versions are done robotically or laparoscopically through small incisions. Robotic ventral mesh rectopexy, one of the newer techniques, has a recurrence rate of about 2.3%, the lowest among available options. Mesh-related complications with the robotic approach appear to be rare. About 6% of patients develop new constipation afterward, so it’s not a perfect solution, but functional outcomes are generally good over the long term.
Abdominal procedures overall carry recurrence rates between 5% and 11%. Hospital stays typically last up to a week, and full recovery takes several weeks. You’ll be advised to avoid heavy lifting during that time and to focus on preventing constipation through fiber and fluids.
Perineal Procedures
For older patients or those with significant health problems that make abdominal surgery risky, perineal approaches are preferred. These are done through the anus without abdominal incisions, usually under regional or even local anesthesia. The two main techniques are the Delorme procedure, which removes excess mucosal tissue, and the Altemeier procedure, which removes a segment of the rectum from below.
Recovery is faster with perineal surgery. Hospital stays are typically two to three days. The tradeoff is a higher recurrence rate. The Delorme procedure has a recurrence rate around 5%, while the Altemeier procedure recurs in roughly 12% of cases. Overall, perineal approaches recur at about 6%, compared to 2.3% for robotic abdominal repair. Complication rates also differ: about 1.6% of robotic rectopexy patients experienced postoperative complications in a recent review, compared to 11% after perineal procedures.
What Recovery Looks Like
After either type of surgery, the early weeks focus on keeping stools soft and avoiding any straining. You’ll increase fiber gradually, drink plenty of water, and likely use stool softeners. Lifting restrictions are standard for at least six weeks after abdominal surgery. Most people return to normal activities within a few weeks of perineal surgery, or several weeks after abdominal surgery.
Bowel function can be unpredictable in the first months. Some people notice improvement in continence right away, while others find it takes time for the muscles and nerves to adjust. It sometimes takes several months to know what your long-term bowel function will look like. If you had significant incontinence before surgery, some degree of it may persist, since the prolapse itself can stretch and weaken the sphincter over time.
Strangulation: The Emergency Scenario
The most serious complication of rectal prolapse is incarceration, where the tissue comes out and can’t be pushed back, followed by strangulation, where blood supply to the trapped tissue is cut off. Signs include severe pain, tissue that turns dark or black, and swelling that worsens rapidly. This requires emergency surgery, typically a perineal rectosigmoidectomy, which removes the damaged section of bowel from below. Surgeons avoid going through the abdomen in these cases to prevent contamination from necrotic tissue. This situation is uncommon, but it’s the reason persistent prolapse shouldn’t be ignored indefinitely.