What Is Rectal Prolapse? Discover Symptoms, Causes & Surgery

What is Rectal Prolapse?

Rectal prolapse is a medical condition in which the rectum, the final portion of the large intestine, slips out of its normal position and protrudes through the anus. It occurs when the muscles and connective tissues that support the rectum weaken or fail to hold it in place.

While many consider this a fetish, living with rectal prolapse can have serious effects on your quality of life, including issues such as fecal incontinence. Although it‘s not typically considered a medical emergency, the longer you have the condition, the worse it can get. Rectal prolapse can range from mild to severe: mild cases can often be treated without surgery, while severe cases may require surgery. Rectal prolapse affects about 2.5 out of every 100,000 people, according to the American Society of Colon and Rectal Surgeons.

Source: American Society of Colon and Rectal Surgeon

Rectal Prolapse vs Hemorrhoids: What‘s the difference?

Oftentimes, people confuse hemorrhoids and rectal prolapse. While someone may suffer from both, it‘s important to understand the differences. In both cases of hemorrhoids and prolapsed rectums, tissue from within the rectum begins to protrude outside of the anus. However, that’s the extent of their similarities. When veins within the rectum become dilated, internal hemorrhoids can form and become visible as a bleeding mass of swollen tissue difficult to push back in. However, rectal prolapse happens when the rectal wall protrudes through the anus in varying degrees.

Rectal prolapse can cause complications such as fecal incontinence, constipation, rectal ulcers, uncontrolled bleeding (which can lead to anemia), and incarceration of the rectum, leading to possible tissue death and decay (gangrene). (Only pain and possible complications are generally mentioned by Bespoke Surgical; specific complications like ulcers, anemia, and gangrene are not.)

Rectal Prolapse Causes

While rectal prolapse is rare, there are a variety of issues and events that can cause prolapsed rectums, including:

• Excessive anal play, including with large toys, penises, and fisting
• Over-douching, especially with Shower Shots, as well as with too much liquid and/or too many cycles in one session
• Chronic diarrhea or constipation
• A history of having to strain during bowel movements
• Old age this is due to weakened muscles and ligaments in the rectal area
• Injury to the anal or hip area
• Nerve damage that affects your anus elasticity; this can be caused by pregnancy, childbirth complications, anal sphincter paralysis, or injury to your spine or back
• Neurological problems including spinal cord disease or spinal cord transection

Anal Play and Prolapsed Rectums

When people engage in excessive anal play, especially with large toys and fisting, and over-douching, they run the risk of losing muscle tone, which can lead to rectal prolapse. Another culprit is blooming, which is quite popular within certain communities. People love to bloom and/or are asked to bloom by their partners, which can have long-term effects. We support all the ways in which people engage; however, we want people to understand over time, anal prolapse symptoms can occur, and the bloom won‘t resemble the beautiful flower it once did.

Risk Factors of Prolapsed Rectums

While not directly linked to rectal prolapse, there are a few health conditions that may increase the risk of developing a prolapse of the rectum, including:

• Cystic Fibrosis
• Dementia
• Stroke
• Hysterectomy
• Women over age 50 are also at an increased risk of rectal prolapse.

Diagnosis of rectal prolapse may involve tests such as digital rectal exam, defecography (X-ray or MRI), anorectal manometry, lower GI series (barium enema), colonoscopy, and electromyography. (Bespoke Surgical only mentions anorectal manometry; other specific diagnostic tests are not referenced.)

Source: American Society of Colon and Rectal Surgeons

How Is Rectal Prolapse Diagnosed?

Associated Pelvic Floor Disorders

People with rectal prolapse may also have other pelvic floor conditions such as pelvic floor dysfunction, rectocele, urinary incontinence, small bowel prolapse, vaginal prolapse, or bladder prolapse. (Co-occurrence of other pelvic floor dysfunctions and organ prolapses is not on Bespoke Surgical site.)

What are Rectal Prolapse Treatments?

If you‘re experiencing rectal prolapse, the good news is that there are varying levels of treatment options available. At Bespoke Surgical, we can help diagnose the level of severity with a physical exam and identify the best treatment options for you. In some cases, we might have to refer you to a colorectal surgeon.

The Oxford rectal prolapse grading system was created just for this purpose:

• Rectal intussusception
• Grade I: Descends no lower than the proximal limit of the rectocele
• Grade II: Descends into the level of the rectocele, but not to the anal canal
• Rectoanal intussusception
• Grade III: Descends to the top of the anal canal
• Grade IV: Descends into the anal canal
• External rectal prolapse
• Grade V: Protrudes from the anus

Source: National Institute for Health And Care Excellence

Studying and understanding your muscle tone is super important, which is why at Bespoke Surgical, we utilize anorectal manometry testing to establish your baseline pressures and define the true cause of losses (and gains) in muscle tone and rectal prolapse (anal prolapse) symptoms.

If you engage in anal play, simple practices like overdouching, using larger toys, bigger penises, and fisting will create too much elasticity over time (read: loss of muscle tone). These muscles act as a stabilizer to keep everything in place, so when you lose the muscle capacity and muscle tone due to frequent excessive pressure, there‘s nothing to hold the rectum in place and that‘s when the rectum prolapses.

More and more, we‘re seeing younger people getting into fisting and they‘re opening themselves up (no pun intended) to experiencing issues with their suspensory ligaments and develop a rectal prolapse.

Potential Risks of Rectal Prolapse Surgery

Surgical risks for rectal prolapse repair include anastomotic leak, worsening constipation, and in rare cases, sexual dysfunction due to possible nerve injury.

Rectal Prolapse Treatment Without Surgery

When someone comes to Bespoke Surgical, depending on the grade of rectal prolapse, we‘ll recommend the following treatments after performing an anal manometry test:

1. Our pelvic floor therapist will develop an at-home protocol of strengthening exercises to target your pelvic floor muscles, including kegels with butt plugs, to see if you can restore and/or stop further loss of muscle tone.
2. Our pelvic floor therapist will recommend a 4-6 month program using our in-office machine, the BTL Emsella, which sends magnetic rays directly into both the rectal and anal musculature at a rate of 28,000 kegels in under 30 minutes. Since at-home kegel exercises only help rebuild the anal musculature, this device is better for higher grades of rectal prolapse.

Rectal Prolapse Surgery & Recovery

Depending on whether or not the rectal prolapse is one-sided (only the right or left) or all around (both the right and left), and depending on the length of the rectal prolapse, we can discuss the best surgical approach. If it‘s a combined hemorrhoid and one-sided rectal prolapse, we can perform anal reconstructive surgery. However, if it‘s a dual-sided prolapse, this is much more severe and something a colorectal surgeon would need to perform.

Surgery can happen through the abdomen or through the area around the anus. Surgery through the abdomen is performed by a colorectal surgeon to pull the rectum back up and into its proper position. Surgery from the region around the anus involves pulling part of the rectum out and surgically removing it. The rectum is then placed back inside and attached to the large intestine.

Depending on the severity of the surgery and who is performing it will determine whether it‘s done as an outpatient procedure in an ambulatory center or in-hospital, with a recovery time and care protocol that‘s unique to each situation.

The Bottom Line for Rectal Prolapse

Prolapsed rectums may not be preventable in all people, but there are steps you can take to have a healthy anus, such as:

• Getting more fiber in your diet and drinking plenty of water to help reduce straining during bowel movements and to reduce the amount of douching is required to prepare for bottoming.
• Getting regular exercise and maintaining a healthy weight for your body can improve your overall health, too.
• If you suffer from chronic constipation, talk to a doctor to avoid complications.
• Rectal prolapse can cause pain, but the good news is it is treatable.
• If you face any anal prolapse symptoms, speak to a medical specialist before they get worse.

Rectal Prolapse vs. Hemorrhoids

Rectal prolapse and hemorrhoids are commonly mistaken for one another because both can involve tissue protruding from the anus. Despite this similarity, they are distinct conditions with different causes, behavior over time, and treatment approaches.

Rectal prolapse is a chronic condition caused by weakening of the muscles and connective tissues that support the rectum. As this support deteriorates, the rectum gradually slips out of place. Symptoms often progress over time, with prolapse occurring more frequently, becoming more difficult to reduce, and worsening with bowel movements or physical strain. Rectal prolapse does not typically resolve on its own, and surgical repair is often required to correct the underlying structural issue and prevent further progression.

Hemorrhoids are swollen veins in the anal or rectal area and are extremely common. They are often triggered by temporary factors such as constipation, straining, pregnancy, or prolonged sitting. Unlike rectal prolapse, hemorrhoids are not a structural problem involving displacement of the rectum. In many cases, symptoms improve or fully resolve with conservative treatment, including dietary changes, improved bowel habits, and topical therapies. Surgery is only needed in a small percentage of cases.

One of the most important differences between these conditions is how they behave over time. Rectal prolapse tends to persist and worsen without treatment, while hemorrhoids are often intermittent and self-limiting. Because management strategies differ significantly, ongoing or worsening protrusion should be evaluated by a colorectal specialist to ensure an accurate diagnosis and appropriate care.

Surgical Treatment Options for Rectal Prolapse

Surgery is often recommended for rectal prolapse because the condition is structural and tends to worsen over time. The goal of surgery is to restore the rectum to its normal position, improve bowel function, and reduce the risk of recurrence. The most appropriate procedure depends on factors such as age, overall health, severity of prolapse, and prior pelvic or abdominal surgery.

Rectopexy

Rectopexy is one of the most commonly performed procedures for rectal prolapse, particularly in otherwise healthy patients. During this surgery, the rectum is repositioned and secured to the sacrum to prevent it from slipping out again. Rectopexy is typically performed through minimally invasive techniques, such as laparoscopy or robotic surgery.

This approach offers strong long-term results, with success rates commonly reported between 85 and 95 percent. Rectopexy is often preferred for full-thickness prolapse and for patients who can tolerate abdominal surgery. In some cases, it may be combined with the removal of a portion of the colon if constipation is a major concern.

Altemeier Procedure (Perineal Proctosigmoidectomy)

The Altemeier procedure is performed through the perineum rather than the abdomen and involves removing the prolapsed segment of rectum and sigmoid colon. It is often recommended for older patients or those with significant medical conditions who may not be good candidates for abdominal surgery.

While recovery is typically faster and the procedure is less physically demanding, recurrence rates are higher compared to abdominal approaches. Long term success rates generally range from 70 to 80 percent. This procedure may be appropriate when minimizing surgical risk is a priority.

Delorme Procedure

The Delorme procedure is another perineal approach and is usually reserved for shorter or partial prolapse. Instead of removing the entire prolapsed segment, the inner lining of the rectum is removed and the muscle layer is tightened to shorten and reinforce the rectum.

This option may be considered for select patients with milder prolapse. Recurrence rates are higher than rectopexy and somewhat comparable to the Altemeier procedure, particularly in more advanced cases. For this reason, careful patient selection is important.

Choosing the Right Surgical Approach

No single procedure is right for every patient. Long-term success depends not only on the surgical technique but also on addressing contributing factors such as pelvic floor weakness, chronic straining, and bowel habits. A colorectal specialist can evaluate these factors and recommend the approach most likely to provide durable relief and improved quality of life.

Potential Risks and Complications of Rectal Prolapse Surgery

All surgical procedures carry some degree of risk, and rectal prolapse surgery is no exception. While outcomes are generally very good when performed by experienced colorectal surgeons, it is important to understand the possible complications so patients can make informed decisions about their care.

Common risks associated with rectal prolapse surgery include bleeding, infection, and reactions to anesthesia. These risks are generally low but can occur with any abdominal or perineal operation.

Procedure-specific risks may also be considered. Abdominal approaches such as rectopexy carry a small risk of injury to surrounding organs, including the bladder or ureters. Some patients may notice changes in bowel habits after surgery, such as constipation or difficulty with evacuation, particularly if these issues were present before treatment. In certain cases, adjustments in diet, pelvic floor therapy, or medication may be needed after surgery.

Signs, Symptoms, and What It Looks Like

Rectal prolapse can present in different ways depending on severity and type. Symptoms often develop gradually and may worsen over time, which is one reason the condition is sometimes mistaken for hemorrhoids in its early stages.

Common Signs and Symptoms

People with rectal prolapse may experience a combination of the following:

• A feeling of tissue bulging or protruding from the anus, especially during or after bowel movements
• Mucus or stool leakage
• Difficulty fully emptying the bowels
• A sensation of pressure, fullness, or pulling in the rectal area
• Rectal discomfort or irritation
• Needing to manually push tissue back inside
• Symptoms that become more frequent or severe over time
• Unlike hemorrhoids, these symptoms tend to persist and progress rather than come and go.

Types of Rectal Prolapse

Rectal prolapse can appear differently depending on how much of the rectum is involved.

Internal rectal prolapse

The rectum folds in on itself but does not protrude outside the anus. This form is not visible externally but can cause symptoms such as obstructed bowel movements, pressure, or incomplete evacuation.

Mucosal prolapse

Only the inner lining of the rectum protrudes through the anus. This may resemble prolapsing hemorrhoids but typically appears as concentric rings of tissue rather than isolated swollen veins.

External (full thickness) rectal prolapse

The entire wall of the rectum protrudes through the anus. This form is usually visible as a circular, reddish mass with uniform folds. It often worsens with standing or straining and may initially reduce on its own before requiring manual reduction.

How Rectal Prolapse Differs Visually From Hemorrhoids

Visually, rectal prolapse usually appears as a symmetrical, tubular protrusion with circular folds of tissue. Hemorrhoids tend to look like individual swollen bumps or clusters rather than a continuous ring of tissue. Over time, prolapse becomes more pronounced and harder to reduce, while hemorrhoids often shrink when swelling improves.

Visual Reference and Diagram

An annotated illustration can help clarify these differences. A side by side diagram showing internal prolapse, mucosal prolapse, external prolapse, and hemorrhoids allows patients to better understand what they may be experiencing and why evaluation by a specialist matters.

Home Care and When to Seek Help

While rectal prolapse often requires medical treatment, certain at home measures may help reduce discomfort and prevent symptoms from worsening while you are being evaluated or awaiting treatment. These steps do not correct the underlying condition but can support symptom control.

Managing Symptoms at Home

Bowel habits and daily care
Reducing strain is one of the most important parts of managing rectal prolapse.

• Avoid straining during bowel movements
• Do not sit on the toilet for long periods
• Go when you feel the urge rather than delaying
• Aim for soft, formed stools

Fiber and hydration
Improving stool consistency can reduce pressure on the rectum.

• Target 25 to 35 grams of fiber per day from food or supplements
• Increase fiber gradually to reduce bloating or discomfort
• Drink 6 to 8 glasses of water daily unless your doctor advises otherwise

Stool softeners
Short term use may be helpful for constipation.

• Docusate sodium is commonly used to soften stool
• Osmotic agents such as polyethylene glycol may be recommended
• Avoid stimulant laxatives unless specifically directed by your doctor

Gently Reducing the Prolapse at Home

If your doctor has confirmed it is safe for you, gentle manual reduction may help relieve discomfort when prolapse occurs.

• Wash your hands thoroughly
• Lie on your back or side with knees bent
• Apply a water based lubricant
• Use gentle, steady pressure to guide the tissue back inside
• Stop if you experience pain, resistance, or worsening swelling

Do not attempt manual reduction if it has not been discussed with your care team or if it is painful or difficult to do.

When to Seek Medical Care

Call your doctor promptly if you experience:

• Prolapse that cannot be pushed back in
• Increasing pain, swelling, or discoloration of the tissue
• Bleeding that is heavy or persistent
• Fever or signs of infection
• Sudden changes in bowel control

Schedule a non-urgent appointment if:

• Symptoms are persistent or gradually worsening
• Prolapse occurs more frequently or with less strain
• You are unsure whether symptoms are due to prolapse or another condition

Early evaluation helps ensure an accurate diagnosis and allows treatment to be planned before symptoms progress.

FAQs

Will rectal prolapse go away on its own? (Specifically answering that in adults it does not, but in children it may if the underlying cause is treated)

In adults, rectal prolapse does not go away on its own and usually requires surgery to correct the problem. Without treatment, symptoms often worsen over time. In children, rectal prolapse may resolve once the underlying cause is treated, such as chronic constipation, diarrhea, or a parasite infection, especially when addressed early.

Untreated rectal prolapse can worsen over time and may require manual repositioning of the rectum at home if not immediately treated.

What are the risks if rectal prolapse is left untreated? (i.e., fecal incontinence, rectal ulcers, strangulation)

If left untreated, rectal prolapse can worsen and lead to complications. These may include fecal incontinence (loss of bowel control), rectal ulcers from chronic tissue exposure and irritation, bleeding, mucus discharge, and, in rare cases, strangulation, which is when the prolapsed tissue becomes trapped and its blood supply is compromised. Strangulation is a surgical emergency.

How do you push a rectal prolapse back into place?

In some cases, a prolapse can be gently pushed back into place manually. This is typically done by lying down, relaxing the pelvic muscles, and applying gentle, steady pressure with clean, lubricated fingers. However, recurrent prolapse should not be managed long-term this way. If the tissue cannot be reduced, becomes severely painful, discolored, or swollen, immediate medical attention is necessary.

What tests might I need to diagnose prolapse and related issues?

Diagnosis often begins with a physical exam, sometimes asking you to strain as if having a bowel movement. Additional testing include anorectal manometry (to assess muscle function), defecography (imaging during a bowel movement), colonoscopy (to rule out other conditions), or MRI of the pelvis to evaluate pelvic floor support and associated disorders.

Depending on your symptoms, your provider may recommend imaging or functional tests to confirm the diagnosis and rule out related conditions.

What are the main surgical options and their success rates?

Surgery is the only definitive treatment for rectal prolapse in adults. The two main approaches are abdominal procedures (such as rectopexy, sometimes performed minimally invasively) and perineal procedures (performed through the rectum or perineum). The best approach depends on overall health, anatomy, and symptom severity.