Overview
Rectal prolapse is when the rectum (the last part of the large intestine) loses its normal attachments and slides down and out through the anus. It can be partial (mucosa only) or full-thickness. Different from hemorrhoids — prolapse involves the entire bowel wall.
Symptoms
A reddish-pink bulge coming out of the anus during bowel movements
Initially returns on its own; later requires manual replacement
Eventually may stay out continuously
Mucus or stool leakage
Sensation of incomplete emptying
Constipation or fecal incontinence (often coexist)
Bleeding from rectal mucosa
Self-Care Tips
Avoid straining — use stool softeners.
Use a footstool on the toilet.
Pelvic floor exercises (Kegels) for mild prolapse.
Treat chronic cough.
Maintain healthy weight.
When to See a Doctor
Seek medical care promptly if you notice: Prolapse that cannot be replaced; Severe pain or bleeding.
Why it happens
Weakened pelvic floor muscles + chronic straining over years. Risk factors: multiple vaginal deliveries, chronic constipation, chronic cough, pelvic surgery, neurological conditions, connective tissue disorders.
How common it is
Most common in women over 50, especially with history of multiple childbirths or chronic constipation. Less common in younger people.
How it is diagnosed
Often visible on exam, especially when the patient strains. Defecography (special X-ray or MRI) confirms diagnosis and assesses pelvic floor anatomy. Anorectal manometry to assess sphincter function. Colonoscopy to rule out other causes.
Lifestyle and daily habits
Prevent worsening and prepare for surgery.
• Avoid straining — use stool softeners.
• Use a footstool on the toilet.
• Pelvic floor exercises (Kegels) for mild prolapse.
• Treat chronic cough.
• Maintain healthy weight.
Diet
Diet prevents straining.
• High-fiber diet (25-30 g/day).
• 1.5-2 liters of water daily.
• Add psyllium for stool consistency.
Medicines
Medications support symptoms.
• PEG (Movicol) to prevent straining.
• Loperamide if also incontinent with loose stool.
Procedures and surgery
Surgery is the definitive treatment for significant prolapse.
• Abdominal approaches (laparoscopic ventral mesh rectopexy) — best long-term results.
• Perineal approaches (Altemeier or Delorme procedures) — for elderly or unfit patients.
• Biofeedback therapy as adjunct for associated constipation or incontinence.
Outlook
Conservative treatment helps mild cases. Surgery is curative for most patients with significant prolapse — multiple approaches available, results generally good.
Questions to ask your doctor
• Which surgical approach is best for me?
• Will I still have constipation or incontinence after surgery?
• What is the risk of recurrence?
Source and review
This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the SGA Patient Education Panel. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.
Frequently Asked Questions
What is Rectal Prolapse?
How is Rectal Prolapse diagnosed?
What is the outlook for Rectal Prolapse?
When should I see a doctor about Rectal Prolapse?
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