Rectal Prolapse

Unhappy Retired Senior Woman Sitting On Sofa At Home
Medical illustration showing the difference between a normal rectum and a prolapsed rectum

Rectal prolapse most commonly occurs when the rectum – the last portion of the large intestine – turns inside-out and slides out through the anus. Though rare, internal rectal prolapse can occur, where no tissue appears outside the body.

Causes of rectal prolapse

The most common causes of rectal prolapse include chronic constipation and straining to have a bowel movement. These conditions weaken the anal sphincter (tightening muscle), allowing the rectum to move in and out of its natural place.

Women over age 70 are the most affected by prolapse, as they commonly have pelvic floor weakness and a history of childbirth. Men and younger women can also develop rectal prolapse; however, women are six times more likely to experience rectal prolapse than men.

Symptoms of rectal prolapse

If you experience rectal prolapse, your symptoms may include:

  • Bleeding from the irritated prolapsed tissue
  • Constipation, due to being unable to pass stool with the rectum out of place
  • Feeling a bulge in the anal area
  • Mucus draining from the anal area
  • Pain or pressure in the pelvis
  • Fecal incontinence (inability to control bowel movements)

If you are not healthy enough to undergo surgery or choose to live with the prolapse, you may opt for non-surgical management. Non-surgical treatment for rectal prolapse cannot cure the condition, but it can help you manage your symptoms. When the rectal prolapse occurs, the caregiver or the patient can push it back inside the body. Rectal prolapse may happen one to two times weekly, or it may happen several times daily.

Your surgeon may recommend an operation to correct rectal prolapse, or you may need emergency surgery if you or a medical professional can no longer push the exposed tissue back inside your body. Surgery for rectal prolapse include:

  • A rectopexy. Using an incision in your abdomen, your surgeon pulls the rectum up and secures it to your sacrum (the bone directly above the tailbone). This procedure keeps your rectum in position and prevents it from sliding out of place. Surgeons can perform rectopexies in conjunction with a colon resection (removal), if needed.
  • An Altmeier operation. In this procedure, your surgeon removes the bulging rectal tissue appearing outside your body. This surgery is less invasive and is ideal for those who need to avoid general anesthesia (being fully asleep) or for those who need a sphincteroplasty (surgical tightening of the anal muscles) at the same time.