Understanding Rectal Prolapse

Rectal prolapse is a medical condition where the rectum — the final part of the large intestine — moves out of its normal position and may protrude through the anus. This occurs due to weakened support structures in the pelvic area, often referred to as pelvic floor dysfunction. It is most commonly observed in older adults, especially women over the age of 60.

What does rectal prolapse look like?

In a full rectal prolapse, a reddish, moist tissue mass becomes visible outside the anal opening. This protrusion may increase with straining or during bowel movements. Common symptoms include:

• bleeding from the rectum,
• a feeling of incomplete bowel evacuation,
• pain or pressure in the rectal area,
• frequent fecal incontinence or leakage of stool.

In infants, rectal prolapse may occur temporarily during bowel movements and usually resolves on its own. In adults, however, the condition tends to be persistent and may worsen over time without treatment.

How is it diagnosed?

A healthcare professional must perform a physical examination to confirm the presence of rectal prolapse. This may include observing the rectal area while the patient stands, squats, or strains. Diagnostic tests such as colonoscopy, barium enema, or a sigmoidoscopy might also be recommended. Anal sphincter tone is often assessed to evaluate muscle strength.

What causes rectal prolapse?

The condition is usually caused by a weakening of the muscles and ligaments that support the rectum. Contributing factors include:

• aging and natural tissue laxity,
• chronic constipation and frequent straining,
• previous childbirth injuries,
• past rectal or pelvic surgeries,
• neurological disorders or connective tissue conditions,
• in some children, a genetic predisposition.

Available treatments

In children, mild cases of rectal prolapse can often be managed without surgery. Measures such as softening the stool and reducing strain during bowel movements are effective. In some cases, gentle support methods like taping the buttocks (strapping) between bowel movements can help promote healing.

In adults, surgical treatment is typically required. The most common procedure is called rectopexy, which involves lifting the rectum and securing it to the sacrum (a bone at the base of the spine) to keep it in place. In more severe cases, a portion of the rectum may be removed, and the remaining section reattached. The choice of procedure depends on the patient's overall health and the severity of the prolapse.