- Chronic Constipation: Persistent straining during bowel movements places prolonged pressure on the pelvic floor, gradually weakening its muscles and increasing the risk of prolapse.
- Pregnancy and Childbirth: Multiple vaginal deliveries can stretch and weaken the pelvic floor muscles and supporting ligaments, making women more susceptible to rectal prolapse later in life.
- Neurological Conditions: Disorders such as multiple sclerosis, lumbar disc disease, or spinal injuries can impair nerve function, reducing muscle strength and coordination in the pelvic area.
- Age-Related Factors: The natural ageing process leads to a gradual weakening of pelvic muscles and ligaments, increasing the likelihood of prolapse, particularly in older adults.
- Previous Pelvic Surgery: Surgeries involving the pelvic area, such as hysterectomy or colorectal surgery, may disrupt or weaken the structural integrity of the pelvic support system.
Rectal Prolapse

Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Rectal prolapse is a condition in which the rectum, the final part of the large intestine, slips out of its normal position and protrudes through the anal opening. This can cause the rectal tissue to become visible outside the body. The condition often leads to difficulties with bowel movements, discomfort, and other potential complications. Although rectal prolapse can occur in anyone, it is more commonly seen in older adults, particularly women over the age of 50.




Symptoms of Rectal Prolapse
Rectal prolapse occurs when the rectum protrudes through the anus, leading to a range of symptoms. Common symptoms include:
- Tissue Protrusion: A reddish mass may extend outside the anus, particularly during bowel movements or prolonged standing. In severe cases, it may not retract on its own.
- Faecal Incontinence: Weak anal muscles can cause involuntary stool leakage, leading to discomfort and hygiene issues.
- Constipation: Difficulty passing stools and a persistent sensation of incomplete evacuation, often due to obstruction by the prolapsed rectum.
- Mucus Discharge and Bleeding: The exposed rectal tissue can secrete excess mucus, leading to anal irritation. Friction or irritation of the tissue may also cause minor bleeding, often appearing as bright red blood.
Causes and Risk Factors
Rectal prolapse is often caused by a combination of factors that weaken the pelvic floor and supporting structures. These include:
Diagnosis of Rectal Prolapse
Defecography
This specialised X-ray imaging evaluates the movement of the rectum during defecation. A contrast material is inserted into the rectum, and images are taken while the patient evacuates on a specially designed toilet. This test provides detailed insight into rectal function and identifies associated abnormalities such as rectoceles or intussusception.
Physical Examination
The doctor conducts a thorough external inspection of the anal area and performs a digital rectal examination to assess muscle tone and structural abnormalities. The patient may be asked to strain as if passing a bowel movement, which can help demonstrate the prolapse visibly.
Colonoscopy
A flexible, camera-equipped scope is used to examine the entire colon and rectum. This procedure not only rules out other potential conditions, such as colorectal cancer or inflammatory bowel disease, but also identifies issues like polyps or tumours that could contribute to symptoms.
Anorectal Manometry
This test uses specialised pressure sensors to measure the strength of the anal sphincter muscles and the sensitivity of rectal nerves. It provides information about muscle weakness or nerve dysfunction, helping to guide treatment options.
Treatment Options
Treatment for rectal prolapse ranges from conservative management to surgical intervention, based on individual factors and severity.
Non-Surgical Treatment
- Dietary Modifications: Increasing fibre intake through fruits, vegetables, whole grains, and supplements, along with adequate hydration, helps prevent constipation. Regular, soft bowel movements reduce straining, which can aggravate prolapse.
- Pelvic Floor Exercises: Targeted exercises, such as Kegels, strengthen the pelvic muscles that support the rectum. A physiotherapist guides the patient in performing these exercises correctly and develops a tailored, consistent programme for long-term improvement.
- Stool Softeners: Medications such as laxatives or stool softeners ensure softer stools, minimising the need for straining during bowel movements. Dosages are adjusted based on the patient’s response and specific needs.
Surgical Treatment
Transperineum Approaches vs Trans-Abdominal Approaches
- Rectopexy (Rectum Repair Surgery): This procedure involves securing the rectum to the sacrum (the lower part of the spine) using sutures or surgical mesh to hold it in place. Rectopexy can be performed either through open surgery or minimally invasive techniques, such as laparoscopy. The recovery period typically ranges from 4 to 6 weeks.
- Resection (Colon Removal Surgery): In cases where constipation or redundant colon segments contribute to the prolapse, part of the colon is surgically removed. The remaining sections are then reconnected, relieving pressure and preventing recurrence. This procedure is often combined with rectopexy to address both the prolapse and underlying causes effectively.
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Prevention and Management
Preventing and managing rectal prolapse involves maintaining healthy bowel habits and reducing strain on the pelvic floor. A fibre-rich diet, including plenty of fruits, vegetables, and whole grains, combined with 6 to 8 glasses of water daily, helps prevent constipation and supports regular bowel movements.
Regular exercise promotes overall bowel function and strengthens pelvic floor muscles, reducing the risk of prolapse. Additionally, avoiding prolonged sitting on the toilet and straining during bowel movements minimises pressure on the pelvic floor. Promptly responding to the urge to defecate further helps maintain normal bowel patterns and reduces unnecessary strain.
Frequently Asked Questions
Can rectal prolapse resolve without surgery?
Early stages may improve with conservative measures, but complete prolapse typically requires surgical correction. Non-surgical treatments help manage symptoms while preparing for surgery.
What happens if rectal prolapse remains untreated?
Untreated prolapse may lead to increasing bowel control problems, tissue damage, and ulceration, which can cause blood in stools. The prolapsed segment can become trapped outside the body, requiring emergency treatment.
Is rectal prolapse related to haemorrhoids?
Although both conditions involve the anal area, rectal prolapse is a separate condition where the rectum protrudes, while haemorrhoids are swollen blood vessels in the anal canal. It is commonly misdiagnosed and the treatment varies for the two conditions. Hence, it is important to seek medical consultation if you notice or experience a lump at the anus.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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