Rectal prolapse

What is rectal prolapse?

A rectal prolapse occurs when part of the rectum (the lowest part of the large intestine) sticks out of the anus.

A rectal prolapse can be partial or complete.

A partial prolapse means only the inner lining of the rectum (known as the mucosa) sticks out of the anus, usually by just a few centimetres. A complete prolapse involves all layers of the rectum.

The condition tends to affect women aged over 60, but can also occur in men and women of all ages.

A rectal prolapse can be uncomfortable to live with and can affect your quality of life. See a doctor if you have, or suspect you may have, a rectal prolapse.

Rectal prolapse symptoms in adults

If you have a rectal prolapse, you may notice a lump sticking out of your anus. In its early stages, the lump may only appear when you poo, but as the condition progresses, you may notice the lump appears:

• more often
• when you sneeze or cough
• when you are walking or standing up
• all the time

A rectal prolapse is usually painless, but it can cause pain if it is particularly large or if the prolapsed part of the rectum gets stuck and can’t be pushed back in.

Other symptoms of a rectal prolapse include:

• difficulty starting a bowel movement
• feeling like you have not fully emptied your bowels after pooing
• mucus or blood coming from your anus
• solid or liquid poo leaking from your anus (incontinence) - less common

What causes a rectal prolapse in adults?

It is not clear why some people develop a rectal prolapse. However, conditions that increase the pressure inside your tummy can increase your risk of prolapse. Such conditions include:

• pregnancy
• long-standing constipation or diarrhoea
• a long-standing cough

Other factors that can increase your risk of the condition include:

• previous surgery anywhere below your belly button (pelvis)
• not being able to properly control the muscles around your bladder, rectum, womb or prostate gland (an area known as the pelvic floor)
• conditions that affect the brain, spinal cord and/or nerves

How is a rectal prolapse diagnosed?

In most cases, a doctor can diagnose a rectal prolapse by looking at your anus.

If the doctor can't see the lump because it has popped back inside your body, they may ask you to squat or sit on the toilet to see if the lump reappears.

You may also need tests to confirm the diagnosis. These may include:

• MRI scan
• colonoscopy, sigmoidoscopy or proctosigmoidoscopy – procedures in which a thin tube with a camera on the end is passed into the colon through your anus
• barium enema – a special fluid is put into your anus to make your bowel easier to see during an X-ray
• proctography – an X-ray or MRI scan is taken while you're having a poo. This helps the doctor see what your bowel and rectum look like when you poo
• anal physiology tests - special tests to check how well the muscles in and around your anus are working

How is rectal prolapse treated?

The treatment you will need for rectal prolapse usually depends on your symptoms and if you have other health problems.

Self-care

In most cases, when part of your rectum pops out of your anus, you can usually pop it back in by gently pushing it with your hand. If you are unable to push the lump back in or doing so is painful, see a doctor or go to a hospital immediately.

You can help to improve the symptoms of rectal prolapse by preventing potential underlying causes like constipation. You can do this by drinking lots of water (up to 8 cups per day) and eating foods that are high in fibre - aim to eat 25 to 30 grams of fibre per day.

Taking

Surgical treatment

If you have a rectal prolapse, and you and/or a doctor can’t push your rectum back into your anus, you may need surgery to repair the problem. This may be done through your tummy or your anus.

When can I drive and exercise?

Rectal prolapse can make some daily activities, like driving or exercising, feel uncomfortable. Some of these activities, namely those that involve standing or walking, may also make your symptoms worse.

Speak to a doctor for advice on daily activities you may need to avoid and when it is safe for you to start doing them again.

If you are worried that you may have a rectal prolapse, check your symptoms by downloading our free

Date of last review: 1 July 2020

References

Rectal prolapse in adults (The Basics) [Internet]. Uptodate.com. 2020 [cited 11 February 2020]. Available

Tidy D. Rectal Prolapse. Symptoms of rectal prolapse and treatment. [Internet]. Patient.info. 2020 [cited 11 February 2020]. Available

Overview of rectal procidentia (rectal prolapse) [Internet]. Uptodate.com. 2020 [cited 11 February 2020]. Available

Rectal prolapse [Internet]. Dynamed.com. 2020 [cited 11 February 2020]. Available

Rectal Prolapse and Procidentia - Gastrointestinal Disorders - MSD Manual Professional Edition [Internet]. MSD Manual Professional Edition. 2020 [cited 12 February 2020]. Available

Knott L. Rectal Prolapse - Symptoms, Causes, Diagnosis and Treatment [Internet]. Patient.info. 2020 [cited 12 February 2020]. Available