An anal prolapse, more precisely called a rectal prolapse, happens when part or all of the rectum slides out of place and protrudes through the anus. It can range from a small amount of tissue that pokes out only during a bowel movement to a large, visible mass that stays outside the body. About 80 to 90 percent of adults who develop rectal prolapse are women, and it’s most common in people over age 50.
Types of Rectal Prolapse
Not all rectal prolapse looks or feels the same. There are three main forms, and they differ in how much tissue has shifted out of position.
- Mucosal prolapse (partial): Only the inner lining of the rectum bulges out through the anus. This is the mildest form and often appears as small folds of reddish tissue during straining.
- Internal prolapse (intussusception): The rectum has started to fold in on itself or slide downward, but it hasn’t yet pushed through the anal opening. You can’t see it from the outside, but it can cause a feeling of blockage or incomplete emptying.
- Full-thickness prolapse: The entire wall of the rectum telescopes out through the anus. This is the most advanced form and typically produces a visible, rounded mass of dark pink or red tissue several inches long.
What It Feels and Looks Like
The hallmark symptom is tissue bulging from the anus, especially during or after a bowel movement. Early on, the tissue may slide back inside on its own. Over time, it can stay out longer or require you to push it back in manually. Many people describe a sensation of sitting on a ball or feeling like something hasn’t fully “gone back.”
Other common symptoms include mucus or bloody discharge on underwear, difficulty controlling gas or stool (fecal incontinence), and a persistent feeling that the rectum hasn’t emptied completely. Constipation is both a symptom and a contributing factor: straining creates pressure that worsens the prolapse, which in turn makes bowel movements harder.
What Causes It
Rectal prolapse develops when the muscles and ligaments that anchor the rectum to the pelvis weaken enough that the rectum can no longer hold its position. The exact cause isn’t fully understood, and it’s rarely one single factor. Contributors include aging, chronic constipation or diarrhea, pregnancy and childbirth, previous pelvic surgery or injury, spinal cord or nerve damage, chronic coughing or sneezing, and conditions like cystic fibrosis. Intestinal parasite infections can also play a role.
It’s commonly assumed that vaginal childbirth is the primary driver in women, but roughly one-third of women with rectal prolapse have never had children. Weak pelvic floor muscles appear to be the more important underlying thread, and people with rectal prolapse often have related pelvic floor conditions at the same time.
In children, rectal prolapse is distributed equally between boys and girls and often resolves on its own. In adults, peak occurrence hits in the fourth decade (30s) and again in the seventh decade (60s).
How It’s Diagnosed
A doctor can often identify a full-thickness prolapse just by looking, particularly if you bear down during the exam. Internal prolapse is trickier because nothing is visible from the outside, so additional tests may be needed.
Defecography is an imaging study where a contrast dye is placed in the rectum, and X-rays or MRI scans are taken while you simulate a bowel movement. It reveals structural changes in the lower digestive tract and shows how the rectal muscles are functioning in real time. Anal manometry is another common test: a thin, flexible tube with a small balloon on its tip is inserted into the rectum to measure how tightly the anal sphincter closes and how well the rectum is working. Together, these tests help distinguish rectal prolapse from hemorrhoids, which can look similar on the surface but involve different tissue.
Managing Symptoms Without Surgery
For mild or partial prolapse, lifestyle changes can slow progression and reduce discomfort. The primary goal is eliminating straining during bowel movements. That means increasing dietary fiber to the recommended 18 to 30 grams per day and drinking at least 1.5 to 2 liters of water-based, non-caffeinated fluids daily. If you add bulk-forming supplements like ground linseeds, drink an extra small glass of fluid for each tablespoon you use.
Pelvic floor muscle training is another frontline approach. Biofeedback therapy, guided by a specially trained physiotherapist, teaches you to strengthen the muscles around the anus and rectum. You learn to sense when stool is ready to pass and to contract the right muscles at the right time. Biofeedback won’t necessarily eliminate the need for surgery, but it can make surgery more successful if it becomes necessary and helps prevent the prolapse from coming back afterward.
Surgical Options
Full-thickness rectal prolapse that doesn’t respond to conservative measures typically requires surgery. The two main approaches differ based on whether the surgeon operates through the abdomen or through the anus itself.
Abdominal Repair (Rectopexy)
The surgeon makes an incision in the abdomen (or uses laparoscopic ports), pulls the rectum back into its correct position, and anchors it to the back wall of the pelvis using sutures or a mesh sling. For people with a long history of constipation, the surgeon may also remove a section of the colon to improve bowel function going forward. This is generally the preferred approach for people healthy enough for abdominal surgery, as it tends to have lower recurrence rates.
Perineal Repairs
These procedures are done through the anus without abdominal incisions, making them a better fit for older adults or people with health conditions that increase surgical risk.
- Altemeier procedure: The surgeon pulls the rectum out through the anus, removes the prolapsed portion entirely, then reconnects the remaining rectum to the colon above it. This is the more commonly performed perineal repair.
- Delorme procedure: Used for shorter prolapses, this technique removes only the inner lining of the prolapsed section and folds the muscular wall to shorten the rectum.
Recovery time varies by procedure. Perineal repairs generally involve a shorter hospital stay and faster return to daily activities. Abdominal repairs take longer to heal from but may offer more durable results over time.
When It Becomes an Emergency
Most rectal prolapse is uncomfortable but not dangerous in the short term. It becomes urgent if the protruding tissue gets trapped outside the body and can’t be pushed back in. This is called incarceration, and if left untreated, the trapped tissue can lose its blood supply (strangulation). Signs include severe pain, swelling, and tissue that turns dark red, purple, or black. This situation requires immediate medical attention because tissue death can set in within hours.