Rectal prolapse is a condition where part or all of the rectum slides out of place and protrudes through the anus. It affects roughly 2.5 out of every 100,000 people per year, and while it can happen to anyone, about 80 to 90 percent of adults with the condition are women over age 50. It’s not life-threatening, but it tends to worsen over time without treatment.
How Rectal Prolapse Develops
The rectum is the last section of the large intestine, sitting just above the anus. It’s held in place by muscles and ligaments attached to the pelvic floor. When those supporting structures weaken, the rectum can begin to slip downward. In a full-thickness prolapse, the entire wall of the rectum pushes through the anal opening. In a partial or mucosal prolapse, only the inner lining of the rectum slides out.
One visual distinction matters: a full-thickness prolapse has circular, concentric folds of tissue. Prolapsed hemorrhoids, which can look similar at first glance, have folds that run in a star-like pattern radiating outward. This difference helps doctors tell the two apart during an exam.
Who Is Most at Risk
Chronic straining during bowel movements is the most common contributing factor. Years of constipation, repeated heavy lifting, or chronic coughing put sustained downward pressure on the pelvic floor. Over time, the muscles and connective tissue stretch and weaken. Pregnancy and vaginal childbirth contribute to pelvic floor damage, which helps explain why the condition is so much more common in women. Nerve injuries to the pelvic area, whether from childbirth, surgery, or aging, can also reduce the muscle tone that keeps the rectum anchored.
Rectal prolapse is rare in children. When it does occur, it typically affects kids younger than four and is usually managed without surgery.
What It Feels and Looks Like
The hallmark symptom is a reddish lump of tissue that comes out of the anus, most often during a bowel movement. Early on, the tissue may slip back inside on its own. As the prolapse progresses, it can stay outside the body and need to be manually pushed back in, or it may remain out permanently.
Beyond the visible bulge, other common symptoms include:
- Fecal incontinence: losing control of bowel movements, ranging from minor leakage to full loss of control
- Mucus or blood leaking from the rectum
- Constipation or loose stools, sometimes alternating
- A persistent feeling that your rectum hasn’t fully emptied after a bowel movement
Many people also describe a dragging or heaviness in the pelvic area, especially after standing for long periods. The symptoms tend to start mildly and gradually worsen over months or years, which is why some people delay seeking help.
How It’s Diagnosed
A physical exam is usually the starting point. During a digital rectal exam, a doctor checks the strength of the sphincter muscles and may ask you to bear down as if having a bowel movement. This straining can make a prolapse visible that wouldn’t be apparent at rest.
If more detail is needed, two specialized tests help clarify the picture. Defecography uses a contrast dye combined with X-ray or MRI imaging while you simulate a bowel movement. It reveals structural changes in the lower digestive tract and shows how well the rectal muscles are functioning. Anal manometry involves inserting a thin, flexible tube with a small balloon into the rectum to measure how tightly the sphincter muscles close and how the rectum responds to pressure. These tests help determine the severity of the prolapse and guide treatment decisions.
Non-Surgical Treatment Options
For mild cases, especially partial prolapse, conservative approaches can slow progression and manage symptoms. A high-fiber diet and stool softeners reduce the straining that worsens prolapse over time. Biofeedback therapy, a form of pelvic floor physical therapy, teaches you to strengthen the anal and pelvic muscles through targeted exercises. During biofeedback sessions, trained physiotherapists help you learn to sense when stool is ready to pass and to contract the right muscles at the right time. This type of therapy can be used on its own for early-stage prolapse or alongside surgery to improve outcomes.
In children, stool softeners and other medications are typically enough to resolve the problem without any procedure.
Surgical Approaches
Full-thickness rectal prolapse in adults almost always requires surgery to correct. The two main approaches differ in how the surgeon accesses the rectum.
Abdominal Surgery
The most common abdominal procedure is laparoscopic ventral rectopexy, performed under general anesthesia through small incisions in the abdomen. The surgeon lifts the rectum back into its normal position and secures it, often with a small piece of mesh. This approach works for all degrees of prolapse. Average operating time is about 98 minutes, with a hospital stay of up to a week.
Perineal Surgery
Perineal procedures access the rectum through the anus itself, avoiding abdominal incisions entirely. They’re particularly suited to older patients, people with heart or lung disease, or anyone who can’t safely undergo general anesthesia. The specific technique depends on the size of the prolapse. Smaller mucosal prolapses may be treated with a stapled resection, while larger prolapses require removing the excess rectal tissue or stripping and refolding the inner lining. Operating time averages about 58 minutes, and hospital stays are typically shorter at around two to three days.
How the Two Compare
Despite the differences in recovery time and surgical complexity, both approaches produce similar results where it matters most. Recurrence rates and complication rates are not significantly different between abdominal and perineal surgery. About 10.5 percent of patients experience postoperative complications regardless of approach, and neither method has a clear advantage in preventing the prolapse from returning.
Recovery After Surgery
Hospital stays range from two to three days for perineal surgery up to a week for abdominal procedures. After discharge, returning to normal daily activities takes anywhere from a few weeks to several weeks depending on the approach and your overall health. Most surgeons recommend avoiding heavy lifting and straining during this recovery window.
Biofeedback therapy after surgery can help rebuild pelvic floor strength and improve bowel control, especially if fecal incontinence was a significant symptom before the procedure.
Recurrence Rates Over Time
Rectal prolapse can come back even after successful surgery. A multicenter study tracking patients who had undergone repeat repair for recurrent prolapse found re-recurrence rates of about 6 percent at one year, 12 percent at three years, and 16 percent at five years. Among those whose prolapse did return, about a third experienced it within the first year after surgery. The median time to recurrence was roughly 22 months. These numbers apply specifically to patients who had already experienced at least one recurrence, so first-time surgical success rates are generally better. Still, the possibility of recurrence is a realistic part of the long-term picture, and it’s one reason ongoing pelvic floor strengthening and bowel habit management remain important even after a successful repair.