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# Rectal prolapse

Rectal prolapse is when the [rectum](https://durgical.com/en/anatomy/rectum/) slips out through the anus, either its whole wall or only its lining; it is most common in young children and older women.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Rectum](https://durgical.com/en/anatomy/rectum/)
- [External anal sphincter](https://durgical.com/en/anatomy/external-anal-sphincter/)
- [Puborectalis](https://durgical.com/en/anatomy/puborectalis/)
- [Pubococcygeus](https://durgical.com/en/anatomy/pubococcygeus-muscle/)
- [Iliococcygeus](https://durgical.com/en/anatomy/iliococcygeus-muscle/)
- [Sacrum](https://durgical.com/en/anatomy/sacrum/)
- [Rectouterine pouch](https://durgical.com/en/anatomy/rectouterine-pouch/)
- [Pudendal nerve](https://durgical.com/en/anatomy/pudendal-nerve/)

## Microorganisms that cause it

- [Trichuris trichiura](https://durgical.com/en/microbiology/trichuris-trichiura/)

## In physiology

- [Defecation and continence](https://durgical.com/en/physiology/defecation-and-continence/)

## What it is

Protrusion of the rectum through the anus. In full-thickness prolapse the whole rectal wall turns inside out; in mucosal prolapse only the lining protrudes. It occurs mainly in young children and in older adults, especially women.

## Who gets it

Two peaks: toddlers, usually under about four years, and older adults, in whom women predominate. In children in tropical regions, including Colombia, intestinal parasites such as whipworm and diarrhoeal illness are important triggers.

## Causes

- Children: straining with constipation, acute or chronic diarrhoea, intestinal parasites (Trichuris trichiura), malnutrition
- Children: cystic fibrosis, severe cough (pertussis), neuromuscular disorders such as myelomeningocele, Hirschsprung disease
- Adults: chronic straining, weak pelvic floor and anal sphincter, redundant [sigmoid colon](https://durgical.com/en/anatomy/sigmoid-colon/) and deep [rectouterine pouch](https://durgical.com/en/anatomy/rectouterine-pouch/)
- Adults: neurological or psychiatric conditions, previous pelvic surgery

## Risk factors

- Age under about four or older age
- Female sex in adults, multiparity and previous vaginal births
- Chronic constipation or diarrhoea
- Parasitic infection and malnutrition in children
- Cystic fibrosis
- Pelvic floor dysfunction and [pudendal nerve](https://durgical.com/en/anatomy/pudendal-nerve/) damage

## Pathophysiology

In young children the rectum is straighter and its supports are loose, so straining pushes the mucosa or the whole wall through the anus. In adults, poor sacral fixation, a deep rectouterine pouch, a weak levator ani and a lax sphincter allow the rectum to telescope (intussuscept) and then emerge. Repeated prolapse stretches the sphincter and the pudendal nerves, worsening incontinence.

## Classification

- Full-thickness (complete) prolapse: concentric mucosal folds
- Mucosal (partial) prolapse: radial folds, common in children
- Internal rectal intussusception: telescoping that does not pass the anus
- Incarcerated or strangulated prolapse

## Symptoms and signs

- A red, moist mass protruding from the anus, first only on straining, later with walking or standing
- Spontaneous reduction or need to push it back by hand
- Mucus discharge and rectal bleeding
- Faecal incontinence in many adults; constipation or a feeling of incomplete emptying
- In children: painless red mass after defecation that often reduces on its own

## Red flags

- Prolapse that cannot be reduced, turns dark or purple, or is very painful (incarceration or strangulation)
- Heavy bleeding
- In a child: recurrent prolapse, failure to thrive, chronic cough or greasy stools (test for cystic fibrosis)
- Weight loss, anaemia or change in bowel habit in an adult (exclude cancer)

## Diagnosis

**Clinical**
Seeing the prolapse, ideally while the patient strains on a toilet or squatting; concentric folds suggest full-thickness prolapse and radial folds mucosal prolapse. Digital examination assesses sphincter tone.

**Tests**
In children: stool examination for parasites and a sweat chloride test for cystic fibrosis when the cause is unclear or prolapse recurs. In adults: tests of anal sphincter function (manometry) when planning surgery.

**Imaging**
Colonoscopy in adults to exclude a lead point such as a tumour; defecography for internal intussusception or associated [pelvic floor](https://durgical.com/en/anatomy/levator-ani/) prolapse.

## Differential diagnosis

- Prolapsed internal haemorrhoids (radial grooves between cushions)
- Prolapsing rectal polyp
- Intussusception presenting through the anus in a child
- Rectal or anal cancer
- Anal [skin](https://durgical.com/en/anatomy/skin/) tags

## Goal of treatment

Reduce the prolapse, treat the cause of straining, and in adults correct the anatomy surgically to restore control of the bowel.

## Treatment

**Acute**
Manual reduction with gentle steady pressure (sugar can reduce swelling in oedematous prolapse); urgent surgery for strangulation.

**Conservative**
In children, most cases resolve by treating the cause: stool softening, diet, toilet habits with feet supported, and treating diarrhoea.

**Medical**
Antiparasitic drugs for intestinal worms, nutritional support, and specific management of cystic fibrosis when found.

**Procedure**
Injection sclerotherapy in children with persistent prolapse despite conservative treatment.

**Surgical**
Adults: abdominal rectopexy (often laparoscopic, with or without mesh or resection) for fit patients; perineal operations (Delorme or perineal rectosigmoidectomy) for frail patients, with higher recurrence.

**Rehabilitation**
Pelvic floor rehabilitation and biofeedback for associated incontinence or constipation.

## Complications

- Incarceration and strangulation with ischaemia or necrosis
- Ulceration and bleeding
- Faecal incontinence
- Recurrence after surgery
- Mucosal ulcer of the rectum (solitary rectal ulcer)

## Prognosis

In children the outlook is very good: most resolve with conservative treatment and growth. In adults it rarely resolves without surgery; continence often improves after repair but not always completely.

## Prevention

- Avoiding constipation and prolonged straining
- Deworming and sanitation where intestinal parasites are common
- Good nutrition in children

## Test yourself

Think of the answer, then tap the question to see it.

## How can full-thickness rectal prolapse be told apart from mucosal prolapse?

Full-thickness prolapse shows concentric mucosal folds; mucosal prolapse and haemorrhoids show radial folds.

## Which test should a child with recurrent rectal prolapse and no clear cause have?

A sweat chloride test to look for cystic fibrosis, plus stool examination for parasites.

## Which intestinal parasite is classically linked to rectal prolapse in children?

Trichuris trichiura (whipworm), especially with heavy infection.

## What is the usual first-line treatment of rectal prolapse in children?

Conservative: manual reduction, stool softening and treating the cause; most resolve without surgery.

## Which operations are used for adult rectal prolapse?

Abdominal rectopexy (often laparoscopic) for fit patients; perineal procedures such as Delorme or Altemeier for frail patients.

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## Related conditions

- [Haemorrhoids](https://durgical.com/en/conditions/haemorrhoids/)
- [Pelvic organ prolapse](https://durgical.com/en/conditions/pelvic-organ-prolapse/)
- [Obstetric perineal tears and anal sphincter injury](https://durgical.com/en/conditions/obstetric-perineal-tears-and-anal-sphincter-injury/)
- [Intussusception (children)](https://durgical.com/en/conditions/intussusception/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Pediatric Rectal Prolapse](https://www.ncbi.nlm.nih.gov/books/NBK532308/) (StatPearls (NCBI Bookshelf), 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/rectal-prolapse/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/rectal-prolapse/