Rectal prolapse

Your health experts: Professor Humphrey Scott, Consultant general surgeon and Mr Henry Dowson, Consultant general surgeon
Content editor review by Dr Kristina Routh, December 2022
Next review due December 2025

A rectal prolapse is when the end of your bowel (your rectum) slides out through your anus (back passage), forming a lump. At first, you may only get the rectal prolapse when you're having a bowel movement. But eventually it might be there all the time.

Having a rectal prolapse can be uncomfortable and interfere with your daily life. You may feel embarrassed about it, but it’s important to see your GP if you think you may have one.

An image showing a diagram of the large and small bowels

About rectal prolapse

Your rectum is the last part of your large intestine (bowel). If you have a rectal prolapse, your rectum isn’t kept in place inside your body as it usually is. It may slide out through your anus.

There are three types of rectal prolapse.

Full-thickness (complete) rectal prolapse. This is when the entire thickness of the wall of your rectum slides out.
Partial or mucosal prolapse. This is when just the lining (mucosa) of your rectum slides down inside your rectum and comes out.
Internal rectal prolapse. This is when the lining of your rectum slides down inside your rectum but doesn't reach as far as your anus. This is also known as an internal intussusception.

People of any age can get a rectal prolapse, but it’s most common in women over 60 and young children under three.

Symptoms of rectal prolapse

If you have a rectal prolapse, the most obvious symptom is having a lump or swelling coming out of your anus. At first, you may only notice this after you’ve had a poo – it may go away when you stand up. But if your prolapse gets worse, it may also happen when you strain. For instance, it may happen when you cough or sneeze and when you’re walking or standing up. It may then end up being there all the time.

Other symptoms of a rectal prolapse may include:

being unable to control when you poo – you might not be able to hold it in until you reach the toilet (this is due to stretching of the muscles around your anus)
constipation – feeling like you’re unable to have a poo
having bright red blood coming from your rectum
slimy mucus coming from your rectum, which can be constant and need a pad to stop underwear getting wet
feeling some discomfort or pain

If you have an internal rectal prolapse, you may feel as though you’re not fully emptying your bowels, rather than noticing a lump.

These symptoms don’t necessarily mean you have a rectal prolapse. But if you have any of them, contact your GP.

Hello, I am Dr Naveen Puri, I am one of the GPs within Bupa Health Clinics.

Today I want to speak to you about embarrassing problems you might have and what we can do if you attend one of our clinics.

I want you to know that many people feel embarrassed or concerned about speaking about certain things with their doctors, but I'm here to reassure you these are the kinds of things we deal with every day.

For me, looking at someone's bottom or their breasts or their genitalia is no different to looking at their nose or elbow.

And that's true for all doctors as we train for many years in these parts of the body and are very used to having these conversations with people just like you.

So what I would encourage you to do if you have any concerns from your perspective, be it a change in your bowel habit, be it a lump, a rash, a swelling. Something on your genitalia or a part of your body you're not particularly familiar with or feel uncomfortable discussing.

Please be assured your doctor has done it all before.

Some of the ways we find patients find it easier to speak to a doctor is to either tell the doctor you feel embarrassed up front. That way a doctor can make extra effort to make sure you feel comfortable.

Or some patients come to us with pieces of paper and will write the problem down and hand it to us. That way we can help with whatever is going on for you as well.

You may also find it helpful to ask for a specific doctor, someone you're familiar with in your practice. Or you might want to ask for a doctor of a specific gender, or background to your liking as well.

I'd also say, doctors do this every day so don't be alarmed if we ask you certain questions around your symptoms. It is purely so we can help you get the best outcome for your enquiry.

And then finally, feel free to use language that suits you as well. We don't expect you to know the medical words for things, or a name for your diagnosis. That's our job to find out for you.

So, take your time, see a doctor, and hopefully we can help put your mind at ease.

Hello, I am Dr Naveen Puri, I am one of the GPs within Bupa Health Clinics.

Today I want to speak to you about embarrassing problems you might have and what we can do if you attend one of our clinics.

For me, looking at someone's bottom or their breasts or their genitalia is no different to looking at their nose or elbow.

And that's true for all doctors as we train for many years in these parts of the body and are very used to having these conversations with people just like you.

Please be assured your doctor has done it all before.

Or some patients come to us with pieces of paper and will write the problem down and hand it to us. That way we can help with whatever is going on for you as well.

I'd also say, doctors do this every day so don't be alarmed if we ask you certain questions around your symptoms. It is purely so we can help you get the best outcome for your enquiry.

And then finally, feel free to use language that suits you as well. We don't expect you to know the medical words for things, or a name for your diagnosis. That's our job to find out for you.

So, take your time, see a doctor, and hopefully we can help put your mind at ease.

Diagnosis of rectal prolapse

GP examination

Your GP may be able to diagnose a rectal prolapse by asking about your symptoms and examining you. They’ll need to examine your anus and the area around it. They may ask you to stand up or squat and strain (as if you were having a bowel movement) while they examine you.

Your GP may also ask to carry out a rectal examination to feel inside your back passage. A rectal examination can feel uncomfortable but shouldn’t hurt. Your GP will ensure your privacy, and you can ask to have someone with you during the test.

Referral and further tests

If your GP thinks you have a rectal prolapse, they’ll usually refer you to a colorectal surgeon. This is a doctor who specialises in conditions that affect the bowel.

Your surgeon may recommend further tests. These might be to check the rest of your colon (large intestine) for any other problems before surgery. Or they may be to find out what type of prolapse you have or to try to find the underlying cause.

Tests for rectal prolapse include the following.

Colonoscopy or flexible sigmoidoscopy. Your doctor uses a narrow, flexible, tube-like camera (a colonoscope) to look inside your large bowel.
CT (virtual colonoscopy): A scan assessing the lower bowel. Air is pumped into the bowel and a CT scan performed to check the lining of the bowel.
Proctography (defecography). This is a type of X-ray that shows your rectum and anal canal when you're having a bowel movement.
Rigid proctosigmoidoscopy. This uses a rigid tube with a light to look at the inside of your rectum.
Other tests that look at how the muscles or nerves around your anus are working – for example, an anal manometry.
Other tests may include a CT scan of your abdomen (tummy) and pelvis to check for other problems. You may also be offered an MRI scan of your pelvis to give more information about the prolapse.

If your doctor recommends you have any of these tests, they’ll explain how the test may help and what is involved.

How healthy are you?

With our health assessments you get an action plan that’s tailor-made for you.

To book or to make an enquiry, call us on 0370 218 8122^∧

Find out more about our GP services

Treatment for rectal prolapse

The best treatment for you depends on the type of prolapse you have, as well as other things like your age and your overall health. In young children, a rectal prolapse usually gets better by itself, without any specific treatment. But adults usually need an operation.

Reducing the prolapse

Your doctor may gently push the prolapse back in. This is called ‘reducing’ the prolapse. They may show you how to do this yourself too.

Pushing a rectal prolapse back in needs to be done very gently. You need to try and relax (or encourage your child to relax) while you’re doing it. You’ll probably find it easier to do while lying on your back or side, rather than sitting or squatting. Press gently and steadily on the prolapsed tissue to help it go back inside through the anus. Your doctor may advise you to use a little lubricating jelly to help it slide back in more easily.

If the prolapse won’t easily go back in, your doctor may suggest that you apply some ordinary sugar to it. The sugar helps draw out extra water from the prolapse to make it shrink. If the prolapse still won’t go back in or is painful or you notice dark or bluish-purple tissue, you should seek medical attention as soon as possible. Don’t keep trying to push it back – you may cause damage to the wall of your bowel

Non-surgical

There are certain things you can do before or instead of surgery, to help manage your symptoms, as well as reducing your prolapse. These measures are often enough to manage a partial prolapse.

Treating constipation or diarrhoea. For constipation, this includes eating more high-fibre foods and making sure you’re drinking enough. Try not to strain when you have a bowel movement. Your doctor may also prescribe a laxative if necessary, to soften your poo.
Barrier creams. Your doctor may also recommend that you use barrier creams containing zinc – for example, baby nappy rash creams – around your anus. This is to stop the mucus from the prolapse irritating your skin. Your doctor will advise you what creams to use.
Exercises. Your doctor may also suggest specific exercises you can do to strengthen your pelvic floor muscles and prevent any worsening of the prolapse. They may refer you to a physiotherapist who has an interest in the pelvic floor.

Rectal prolapse surgery

In adults, it’s unlikely that a full-thickness rectal prolapse will go away on its own. Surgery might sometimes be recommended for a partial relapse too. Children may need surgery if they have a complicated rectal prolapse or if their prolapse hasn’t gone away within a year.

If left untreated, a rectal prolapse is likely to get larger and come out more easily. Symptoms such as incontinence (losing control of your bowels) will keep getting worse. And the longer you leave it before having treatment, the more likely it is that your prolapse will return afterwards. There can be other long-term problems too – see our section on complications.

There are many different procedures which surgeons can use to treat a rectal prolapse. Your surgeon will discuss which one they recommend for you.

Surgery for rectal prolapse is carried out in one of the following two ways.

Through your abdomen (tummy). This involves making a cut in your abdomen to reach your rectum and fix it in place (rectopexy). Younger patients usually have this type of surgery. It is usual to have this done with keyhole (laparoscopic) surgery. This is where your surgeon performs the procedure using instruments passed through tiny cuts in your abdomen.
Through your perineum (the area around your anus). It can involve removing part of the prolapsed rectum and sewing in place the remaining section to prevent it happening again. You may be offered perineal surgery if you’re not fit enough for abdominal surgery. This is because you don’t need to have a general anaesthetic for perineal surgery.

If you have a partial (mucosal) prolapse, your surgeon will use different techniques to treat it. The surgery is usually like the kind of surgery you might have for piles (haemorrhoids).

If your surgeon recommends you have an operation, they’ll explain what this involves and how you should prepare. They will explain all the benefits of your surgery and all the possible risks and complications including the chance that the prolapse may come back. You can ask any questions you have, to make sure you’re happy to give your consent to the treatment.

How long it will take to recover from surgery depends on many things, including the type of operation you had and your general health. In general, you will recover more quickly from perineal surgery than abdominal surgery. But everyone is different. Your surgeon can answer any questions you have about likely recovery time.

It’s possible you may have another rectal prolapse after you’ve had surgery. This happens to around one in five people who have surgery for a rectal prolapse.

Causes of rectal prolapse

It’s not clear exactly why some people get a rectal prolapse. However, it’s often linked to having constipation for a long time which makes you strain when you poo. Anything else that increases the pressure inside your abdomen can increase your risk of getting a rectal prolapse too. This includes:

pregnancy
diarrhoea
conditions that make you cough a lot, such as cystic fibrosis, chronic obstructive pulmonary disease (COPD) or whooping cough
an enlarged prostate

Rectal prolapse is also occasionally linked to neurological (nerve) conditions, including:

multiple sclerosis (MS)
lumbar (low back) disc disease
an injury to your lower back or pelvis
spinal tumours

Another factor often seems to be having weak pelvic floor muscles. Your pelvic floor is the supportive sling of muscles and ligaments that keep all your pelvic organs in place. In women, the muscles of your pelvic floor may become weak after you have a baby. Having a weakened pelvic floor means that rectal prolapse can happen at the same time as a prolapsed uterus (womb) or bladder in women.

Complications of rectal prolapse

If a rectal prolapse isn’t treated, it can go on to cause complications. These may include the following.

Ulcers forming on the lining (mucosa) of your prolapsed rectum, which might bleed and make your skin sore.
Incarceration and strangulation of the prolapse. This is when the prolapse gets trapped and its blood supply gets cut off. This is very unusual, but if it happens, the prolapse may become dark red, painful and much more swollen. You may no longer be able to push your prolapse back in. You must seek medical advice straightaway if this happens because you’ll need surgery.

It is important to seek medical advice if you think you may have a rectal prolapse. If a rectal prolapse goes untreated in an adult, it is likely to get bigger and come out more and more easily. Your symptoms will probably just keep getting worse. The longer you leave treatment, the more chance that your rectal prolapse will come back afterwards. So, if you have a rectal prolapse, contact your GP.

Your GP may be able to tell that you have a rectal prolapse just from your description of your symptoms. They will probably want to examine your bottom and probably do a rectal examination too. Try not to feel embarrassed – your doctor really wants to help you. If they think you have a rectal prolapse, they may refer you to a specialist doctor, who may suggest further tests. For more information, see our section on diagnosis.

Rectal prolapse

About rectal prolapse

Symptoms of rectal prolapse

Diagnosis of rectal prolapse

GP examination

Referral and further tests

How healthy are you?

Treatment for rectal prolapse

Reducing the prolapse

Non-surgical

Rectal prolapse surgery

Causes of rectal prolapse

Complications of rectal prolapse

More on this topic

Did our Rectal prolapse information help you?

Rectal prolapse

About rectal prolapse

Symptoms of rectal prolapse

What should I do if I'm embarrassed to talk to my doctor?

Seeing a doctor when you're embarrassed | Watch in 2:08 minutes

Diagnosis of rectal prolapse

GP examination

Referral and further tests

How healthy are you?

Treatment for rectal prolapse

Reducing the prolapse

Non-surgical

Rectal prolapse surgery

Causes of rectal prolapse

Complications of rectal prolapse

More on this topic

Constipation

Piles

Did our Rectal prolapse information help you?