You can’t literally poop out your intestines, but something that looks alarmingly close to it can happen. The medical term is rectal prolapse: the lower end of your rectum slides through the anal canal and protrudes outside your body. It can look like a dark red, fleshy bulge several inches long, and the first time it happens, it’s understandably terrifying. About 2.5 out of every 100,000 people are diagnosed with complete rectal prolapse each year, and while it’s not common, it’s a well-understood condition with effective treatments.
What Actually Comes Out
In a complete rectal prolapse, all layers of the rectal wall push through the anus. The tissue that protrudes is the innermost portion of your rectum, not your small intestine or colon higher up. It typically appears as a moist, reddish tube of tissue with visible circular folds, almost like a sock turned inside out. The length can range from a couple of inches to significantly more in severe cases.
There’s also a milder version called mucosal prolapse, where only the inner lining of the rectum slips out rather than the full wall. This looks similar but involves less tissue and is generally easier to manage. Between the two extremes sits internal prolapse (also called intussusception), where the rectal wall begins to fold in on itself but hasn’t yet pushed through the anus. This internal type often progresses to full prolapse over time if the underlying causes aren’t addressed.
How Prolapse Differs From Hemorrhoids
Many people mistake rectal prolapse for hemorrhoids because both involve tissue bulging from the anus. The key visual difference is the pattern of the folds. Rectal prolapse produces circular, ring-like folds because the entire circumference of the rectal wall is sliding out. Hemorrhoids, on the other hand, create radial folds that fan outward from the center, since they’re swollen blood vessel cushions clustered in specific spots around the anal canal. The distinction matters because the treatments are completely different.
Why It Happens
The exact cause isn’t fully understood, but several factors weaken the structures that keep the rectum in place. Chronic constipation and habitual straining during bowel movements top the list. Years of pushing hard gradually stretch the ligaments and muscles anchoring the rectum to the pelvis. Conditions that damage pelvic floor nerves or weaken pelvic tissues also play a role.
About 80 to 90 percent of adults with rectal prolapse are women, and the median age at diagnosis is 69. Childbirth is often assumed to be the main driver, but roughly one-third of women with the condition have never had children. Men and younger adults can develop it too, particularly those with chronic digestive issues or connective tissue disorders. In children, rectal prolapse is usually self-limiting and tied to constipation or conditions like cystic fibrosis.
What It Feels Like
Early on, the prolapse may only appear during a bowel movement and slide back in on its own. You might notice a sensation of something slipping out, along with incomplete emptying, mucus discharge, or minor bleeding. As the condition progresses, the tissue may protrude with less provocation: coughing, standing up, or even walking. Eventually it can stay out permanently.
Fecal incontinence is common because the stretched anal sphincter muscles lose their ability to close tightly. Many people also experience a persistent feeling of needing to go, even right after a bowel movement. The combination of visible tissue, leakage, and discomfort often leads people to withdraw from normal activities long before they seek help.
When It Becomes an Emergency
Most rectal prolapse is uncomfortable but not immediately dangerous. The situation changes if the protruding tissue can’t be pushed back in. When the rectum stays trapped outside the body, the tight ring of the anus can squeeze off its blood supply, a complication called strangulation. The tissue turns dark purple or black, swells, and becomes intensely painful. Strangulation requires emergency treatment because the tissue will die without blood flow. If you see dark discoloration or experience sudden severe pain in protruding rectal tissue, that’s a situation for the emergency room, not a wait-and-see approach.
How It’s Diagnosed
A physical exam is usually enough. Your doctor may ask you to sit on a commode and strain to reproduce the prolapse, or give you an enema beforehand to make it easier to see. They’ll also check your sphincter tone with a digital rectal exam and look for related pelvic floor problems like bladder prolapse or rectocele (a bulge of the rectum into the vaginal wall).
In some cases, imaging adds useful information. Defecography, a real-time X-ray or MRI taken while you simulate a bowel movement, shows how the pelvic floor and rectum behave during straining. It can reveal internal prolapse that isn’t visible on the outside, and it helps identify additional pelvic floor issues that might need repair at the same time. Pressure testing of the anal sphincter, called manometry, measures how well the muscles open and close, which helps plan treatment and predict outcomes.
Surgical Repair Options
Surgery is the main treatment for complete rectal prolapse. There are two broad approaches, and the choice depends largely on your overall health and ability to tolerate anesthesia.
The abdominal approach, called rectopexy, goes through the abdomen (often laparoscopically) to anchor the rectum back in its proper position. It tends to have the best long-term results: recurrence rates as low as 3 to 5 percent at five years for certain techniques.
The perineal approach works through the anus itself, avoiding abdominal surgery entirely. The most common version, the Altemeier procedure, removes the prolapsed segment of rectum and reconnects the remaining bowel. A less extensive option called the Delorme procedure removes only the inner lining and pleats the muscle wall to shorten it. These perineal procedures are easier to recover from and safer for patients who are older or have significant health problems, but they carry a somewhat higher chance of the prolapse returning. Overall, recurrence after any surgical repair runs about 2 to 5 percent, though some perineal techniques have higher rates over longer follow-up periods.
Preventing Prolapse and Managing Mild Cases
The single most effective preventive step is eliminating straining. That means keeping stools soft enough to pass without effort. A fiber-rich diet or a daily fiber supplement (psyllium husk is the most studied option) adds bulk and moisture to stool. One practical framework used by colorectal specialists targets four goals: spending no more than three minutes on the toilet, going once a day, never straining, and eating enough fiber to make all of that possible.
Pelvic floor exercises can help strengthen the muscles that support the rectum, particularly for people with early or mild prolapse. These exercises involve repeatedly contracting and relaxing the muscles you’d use to stop urinating midstream. For people who have trouble isolating those muscles, biofeedback therapy with a physical therapist specializing in pelvic health can make the exercises more effective. None of these measures will fix a complete prolapse that’s already established, but they can slow progression and improve symptoms in early stages.