Rectal prolapse happens when the muscles and ligaments holding the rectum in place weaken enough that the rectum slides downward and, in some cases, protrudes through the anus. It’s usually not a single event but the end result of a long, gradual process of muscle deterioration. About 80 to 90 percent of adults with rectal prolapse are women, and the condition is most common in people over age 50.
How the Pelvic Floor Fails
Your rectum is held in position by a network of muscles and connective tissue that make up the pelvic floor. These structures act like a hammock, supporting the rectum, bladder, and (in women) the uterus. When the pelvic floor weakens or stretches beyond its capacity, the rectum can fold inward on itself or slide out of place entirely.
Some weakening is a normal part of aging. But anything that puts repeated or excessive pressure on the pelvic floor accelerates that process. Over time, the support system loosens to the point where the rectum can no longer stay anchored, and gravity does the rest.
Chronic Straining and Bowel Habits
Long-term constipation is one of the most common contributors. Years of straining during bowel movements puts direct downward force on the rectum and the muscles holding it in place. Each episode of hard straining is a small insult to the tissue; over decades, the cumulative damage adds up. Chronic diarrhea has a similar effect, not through straining but through the sheer frequency of bowel movements and the irritation that comes with them.
This is also why lifestyle habits matter. Spending long periods sitting on the toilet, bearing down forcefully, or ignoring the urge to go (which leads to harder stools later) all contribute to the slow weakening of rectal support.
Childbirth and Pelvic Injury
Vaginal delivery is one of the strongest risk factors for pelvic organ prolapse in women, which helps explain why the condition is six times more common in women than men. During vaginal birth, the levator muscle (a key part of the pelvic floor) can tear away from the pubic bone, weakening the entire support structure for the rectum, bladder, and uterus. The risk is highest with larger babies, older mothers, and births involving forceps.
The damage doesn’t always show up right away. Many women develop prolapse years or even decades after delivery, as the injured tissue continues to weaken with age. Multiple vaginal births compound the risk, because each delivery adds stress to already-compromised muscles.
Neurological Conditions
The muscles that support the rectum and control the anal sphincter depend on nerve signals from the lower spinal cord. When those nerves are damaged, the muscles can weaken or lose coordination, setting the stage for prolapse. Conditions that affect the lower spinal cord or the nerves branching from it are particularly relevant. These include spinal cord injuries, spina bifida, multiple sclerosis, Parkinson’s disease, stroke, and diabetes (which can damage nerves throughout the body over time).
Nerve damage below the sacral spine directly weakens the pelvic floor and anal muscles. This not only allows the rectum to slip out of position but also impairs the ability to sense when it’s happening, which can delay diagnosis.
Connective Tissue Disorders
Some people are born with tissue that stretches more easily than normal. Ehlers-Danlos syndrome (EDS), a group of genetic conditions affecting connective tissue, is a notable example. People with EDS are prone to hernias, organ displacement, and prolapse because the collagen that holds structures in place is inherently weaker. One form of the condition, caused by a deficiency in a protein called tenascin-X, has been specifically linked to chronic constipation and rectal prolapse, sometimes starting in childhood. Family members of people with this deficiency also show higher rates of these problems, pointing to a clear genetic component.
If you developed rectal prolapse at a younger age than typical, or if you have a history of joint hypermobility, easy bruising, or stretchy skin, a connective tissue disorder could be part of the picture.
Why Children Develop Prolapse
Rectal prolapse in children has a different set of triggers than in adults. The most common cause is simply straining from constipation or diarrhea, and it often resolves once the underlying bowel issue is treated. But in some cases, prolapse in a child signals something more serious.
Cystic fibrosis is one of the most important conditions to rule out. The thick, sticky mucus produced in cystic fibrosis causes chronic constipation and malnutrition, both of which stress the pelvic floor. Rectal prolapse is sometimes the first visible sign that leads to a cystic fibrosis diagnosis. Other causes in children include Hirschsprung’s disease (where nerve cells are missing from part of the colon), tethered spinal cord, malnutrition, and colorectal malformations.
The Three Types of Rectal Prolapse
Not all rectal prolapse looks the same, and the underlying causes can vary by type. Internal prolapse (also called intussusception) is the earliest stage: the rectum folds inward but doesn’t exit the body. You might feel pressure, incomplete emptying, or the sensation that something is blocking the stool. Many people live with internal prolapse without realizing what it is.
Mucosal prolapse involves only the inner lining of the rectum bulging outward. Full-thickness prolapse is the most advanced form, where all layers of the rectal wall protrude through the anus. Full-thickness prolapse typically develops after years of progressive weakening and is the type most likely to require surgical repair.
How Prolapse Is Treated
For mild cases and most children, treatment focuses on removing the underlying cause. Treating constipation or diarrhea, improving nutrition, and strengthening the pelvic floor through exercises like Kegels can stabilize or even reverse early prolapse. In children, the condition frequently resolves on its own once bowel habits improve.
Surgery is the only definitive treatment for full rectal prolapse in adults. The most common approach is rectopexy, performed through the abdomen, where the rectum is lifted back into position and secured to the lower spine with surgical mesh. For older patients or those who can’t tolerate abdominal surgery, perineal procedures offer an alternative. These are performed from outside the body: one option removes the prolapsed portion of the rectum entirely, while another removes just the inner lining and stitches the remaining tissue into a tighter configuration. The choice depends on the size of the prolapse, your overall health, and your surgeon’s assessment.
Recurrence rates vary by procedure, so the goal is to match the surgery to both the cause and the patient. Addressing the factors that led to prolapse in the first place, whether that’s managing chronic constipation, treating a neurological condition, or maintaining pelvic floor strength, is just as important as the repair itself.