Intimate Wellness Institute

Rectal prolapse occurs when your rectum, the lowest part of your large intestine, prolapses out of your anus. It’s caused by a failure of the muscles and connective tissue that hold it in place. Rectal prolapse is often mistaken for hemorrhoids, but it doesn’t go away on its own and needs surgery to fix it.

What is rectal prolapse?

Your rectum is the end of the colon or large intestine. “Prolapse” describes any body part that has fallen from its normal position. With rectal prolapse the rectum has lost the attachments that keeps it in place and when there is pressure to move your bowels it comes throughthe anus with the feces and can come outside the body.  Some weakening or deterioration is normal with aging, but rectal prolapse is not normal.  Childbirth, chronic constipation or diarrhea are major risk factors.

Who does rectal prolapse affect?

It most commonly affects women after childbirth especially over the age of 50 and is relatively common.

Is rectal prolapse serious?

While rectal prolapse is not truly emergent it can cause severe discomfort and lead to the inability to move your bowels, obstructed defecation, or fecal incontinence.  Living with it for any length of time can be very difficult.

What causes rectal prolapse?

Failure of the connective tissue and muscles that hold the rectum in place leads to rectal prolapse. There are numerous risks.  The most common are:

  • Pregnancy and childbirth.
  • Previous injury or surgery to your pelvis.
  • Chronic constipation or diarrhea.
  • Chronic coughing or sneezing.
  • Obesity
  • Spinal cord or nerve damage.
  • Pelvic organ prolapse

What are the signs or symptoms of rectal prolapse?

  • A feeling of pressure or bulging in your anus.
  • A feeling like there’s something is still in your rectum after moving your bowels.
  • A red, fleshy mass coming out of your anus.
  • Persistent leakage of mucus, feces or blood from your anus.
  • Rectal pain and irritation

How do I know if I have rectal prolapse or hemorrhoids?

Rectal prolapse and hemorrhoids can have some similar symptoms, and it can be hard to tell the difference. Hemorrhoids are swollen blood vessels in the anus or rectum.  They cause itching, pain or bleeding. Hemorrhoids can also prolapse and they may look similar to rectal prolapse. Both hemorrhoids and rectal prolapse are common after pregnancy, or with chronic constipation or diarrhea. Hemorrhoids are mainly caused by excessive straining and will go away on their own after a week or so. Rectal prolapse is chronic and progressive and associated with much more difficulty passing feces. The symptoms may change, but won’t go away.


How is rectal prolapse diagnosed?

Dr. Guerette and the IWI team will review your medical history and perform an exam. Additional tests are usually performed to confirm and determine the extent of the diagnosis:

  • Defecography. This is an imaging study of your muscles and rectum when you move your bowels, using an X-ray or MRI.
  • Anorectal Manometry. This test assesses the nerve and muscle function of the rectum and anus.
  • Lower GI Series (barium enema). A series of video X-rays of your lower gastrointestinal tract.
  • Colonoscopy. This test examines the inside of your large intestine with a flexible scope.
  • Electromyography (EMG)This test determines if nerve damage is the reason why the anal sphincters are not working properly. It also examines muscle coordination.

If you have rectal prolapse it is common to have additional pelvic floor disorders. Dr. Guerette will check for these conditions so that they can be addressed together. Common additional conditions include:


Will rectal prolapse go away on its own?

If you’re an adult rectal prolapse won’t improve without surgery.

What happens if rectal prolapse is left untreated?

Untreated rectal prolapse can lead to several possible complications, including:

  • Fecal incontinence. As your anal muscles continue to weaken, you may have increased difficulty holding in gas and feces. With rectal prolapse, up to 75% of people report this issue.
  • Constipation. Collapsing of the rectum and muscle dysfunction will difficulty evacuating your stool. Some people have alternating constipation with incontinence.
  • Rectal ulcers. Friction and exposure of the lining of your rectum on underclothing may cause the tissue to breakdown and form ulcers and painful sores which can bleed. Uncontrolled bleeding is possible.
  • Incarceration. An “incarcerated” rectum gets stuck hanging out of your anus and can’t be pushed back in. The danger of this is that it could become cut off from blood supply (“strangulation”). This is a surgical emergency.

How do you fix rectal prolapse?

There are two main surgical approaches to fixing rectal prolapse. From the abdomen to through the anus.  Which procedure is best depends on the specifics of your condition but for women who are reasonable surgical candidates an abdominal approach with a rectopexy is the most successful. 

Abdominal approach (rectopexy)

This procedure restores your rectum to its original position in your pelvis. The rectum is attached to the sacrum (a ligament over your tailbone) with permanent stitches. This is typically reinforced with mesh. A rectopexy is traditionally done with open surgery (a large incision to  access your organs) or laparoscopic surgery, done through small incisions with a camera. Both procedures need general anesthesia.

Robotic Rectopexy:  Dr. Guerette is the most experienced robotic pelvic reconstructive surgeon in the region and has developed a robotic rectopexy technique that is significantly less invasive and more successful than standard techniques.  With this technique Dr. Guerette uses a graft to re-establish the ligamentous support of the rectum.  This a done with specialized “knotless” suture”.  A robotic rectopexy with Dr. Guerette has a 97% long-term success rate. 

Rectal approach (perineal)

If abdominal surgery isn’t an ideal option for you a trans-rectal approach through your anus is possible. Rectal surgery doesn’t always require general anesthesia as abdominal surgery does. Some people can have it with epidural or spinal anesthesia. The rectal or “perineal” approach may also be a better choice if you have a very minor prolapse. There are two common procedures:

Altemeier procedure. In this procedure, your surgeon pulls the prolapsed rectum out through your anus and removes it. Then the large intestine (your remaining colon and your anus) is put back together

Delorme procedure. If you only have a mucosal prolapse, or a small rectal prolapse, Dr. Guerette may choose a more minor procedure. The Delorme procedure only removes the prolapsed mucosal (inner) lining of your rectum. The tissue is then folded back to the muscle wall of the rectum and stitched in place.  


How can I prevent rectal prolapse from occurring or from recurring after surgery?

  • Treat chronic bowel disorders. Don’t let chronic constipation or diarrhea persist. 
  • Strengthen your pelvic floorThe Intimate Wellness Center’s pelvic floor physical therapy program is a critical part of long-term success.

The Intimate Wellness Institute’s team of expert understands how devasting rectal prolapse can be and how difficult and embarrassing it can be to get help.  We are here to make you comfortable and get you better. If you are suffering from rectal prolapse contact IWI for a consultation.