7 Key Rectal Prolapse Symptoms You Should Never Ignore

Rectal prolapse is a medical condition where part or all of the rectum slips out of its normal position and protrudes through the anus. This condition can be both physically uncomfortable and emotionally distressing for those affected. While it can occur in anyone, it’s most commonly seen in older adults, particularly women, and in young children. Understanding the symptoms of rectal prolapse is crucial for early detection and timely medical intervention.

The rectum is the final section of the large intestine, ending at the anus. When the tissues that hold the rectum in place become weakened or stretched, the rectum can slide down and emerge from the body. This can happen during bowel movements or other activities that increase abdominal pressure. Recognizing the warning signs early can help prevent the condition from worsening and improve treatment outcomes.

In this comprehensive guide, we’ll explore the most common symptoms of rectal prolapse, helping you identify when it’s time to consult with a healthcare professional.

1. Visible Tissue Protruding from the Anus

The most obvious and characteristic symptom of rectal prolapse is the visible protrusion of tissue from the anal opening. This tissue is actually part of the rectal wall that has slipped out of place and extends beyond the anus.

In the early stages, this protrusion may only occur during bowel movements or when straining, and the tissue may retract on its own afterward. The protruding tissue typically appears as a red, moist, finger-like projection that can range from a few centimeters to several inches in length.

As the condition progresses, the prolapse may become more persistent and fail to retract spontaneously. In severe cases, the rectum remains outside the body continuously, requiring manual repositioning. The protruding tissue may become:

• Swollen and inflamed
• Discolored or darker in appearance
• Irritated from exposure and friction
• Increasingly difficult to push back inside

This visible prolapse can be alarming when first noticed, but it’s important to remain calm and seek medical evaluation promptly.

2. Rectal Bleeding

Rectal bleeding is a common symptom experienced by individuals with rectal prolapse. The bleeding occurs because the delicate rectal tissue protruding from the body becomes irritated, inflamed, and damaged.

The exposed rectal mucosa is not designed to be outside the body and is particularly vulnerable to injury from:

• Friction against clothing or during walking
• Wiping after bowel movements
• Drying out due to exposure to air
• Trauma during attempts to push the tissue back in

The bleeding associated with rectal prolapse typically presents as:

Bright red blood on toilet paper after wiping, indicating fresh bleeding from the surface of the prolapsed tissue. The amount can vary from small spots to more significant bleeding.

Blood in the toilet bowl or mixed with stool, which may range from streaks to more noticeable amounts depending on the severity of irritation.

Blood stains on underwear in cases where the prolapse is persistent and constantly exposed to friction.

While the bleeding is usually not severe enough to cause anemia, persistent or heavy bleeding should be evaluated by a healthcare provider to rule out other conditions and prevent complications.

3. Mucus Discharge

An unusual and often bothersome symptom of rectal prolapse is the discharge of mucus from the anus. The rectum naturally produces mucus to help lubricate the passage of stool, but when prolapsed, this mucus production can increase significantly.

The exposed rectal tissue responds to irritation and inflammation by producing excess mucus as a protective mechanism. This discharge can be:

Continuous or intermittent: Some people experience constant mucus leakage, while others notice it only at certain times, particularly after the prolapse has been protruding for a while.

Clear to yellowish in color: Normal rectal mucus is typically clear or slightly white, but inflammation can cause it to appear yellowish or slightly cloudy.

Accompanied by moisture: The constant mucus discharge keeps the anal area persistently moist, which can lead to:

• Skin irritation and itching around the anus
• Discomfort and a feeling of wetness
• Staining of underwear
• Unpleasant odor if not managed with proper hygiene
• Increased risk of skin breakdown and infection

Many people with rectal prolapse find the mucus discharge socially embarrassing and may need to use absorbent pads to manage it.

4. Fecal Incontinence and Leakage

One of the most distressing symptoms associated with rectal prolapse is the loss of bowel control, medically known as fecal incontinence. This occurs because the prolapse affects the normal function of the anal sphincter muscles, which are responsible for controlling bowel movements.

When the rectum prolapses, it stretches and weakens the anal sphincter muscles over time. This weakening impairs their ability to maintain a tight seal, leading to various degrees of bowel control problems:

Passive incontinence: Unintentional leakage of stool or gas without awareness, often occurring during daily activities or sleep. This happens because the weakened sphincter cannot maintain adequate pressure.

Urge incontinence: Feeling the need to have a bowel movement but being unable to hold it long enough to reach a bathroom. The damaged sphincter muscles cannot resist the pressure effectively.

Fecal soiling: Small amounts of stool leak out and stain underwear, particularly after bowel movements or during physical activity. This is often accompanied by the mucus discharge mentioned earlier.

The severity of incontinence can range from occasional minor leakage to complete loss of bowel control. This symptom significantly impacts quality of life, causing:

• Social anxiety and embarrassment
• Reluctance to leave home or participate in activities
• Need for protective undergarments
• Psychological distress and depression

5. Feeling of Incomplete Bowel Evacuation

Many individuals with rectal prolapse experience a persistent sensation that their bowels haven’t completely emptied, even after having a bowel movement. This feeling of incomplete evacuation, also called tenesmus, can be both frustrating and uncomfortable.

This symptom occurs because the prolapsed rectal tissue creates an abnormal sensation and may physically obstruct the normal passage of stool. The brain receives signals that something is still present in the rectum, even when it has been fully emptied.

Characteristics of this symptom include:

Constant fullness: A persistent feeling that there is still stool in the rectum that needs to be passed, leading to repeated trips to the bathroom.

Straining without results: The urge to push and strain during bowel movements, even when no more stool will pass. This straining can ironically worsen the prolapse.

Discomfort and pressure: An uncomfortable sensation of pressure or fullness in the rectal area that doesn’t resolve after defecation.

This symptom can lead to a problematic cycle where the person strains excessively trying to achieve complete evacuation, which further weakens the supporting tissues and worsens the prolapse. It may also result in:

• Spending excessive time on the toilet
• Multiple bowel movements throughout the day
• Increased frustration and anxiety about bowel habits
• Hemorrhoid development from excessive straining

6. Pain and Discomfort in the Rectal Area

While rectal prolapse is not always painful, many people experience varying degrees of discomfort and pain associated with the condition. The level of pain can depend on the severity of the prolapse, how long the tissue has been protruding, and whether complications have developed.

Common pain-related symptoms include:

Aching or pressure sensation: A dull, persistent ache in the rectal and lower abdominal area, often described as a feeling of heaviness or pressure. This discomfort typically worsens when standing or walking and may improve when lying down.

Sharp pain during bowel movements: The passage of stool over the inflamed, prolapsed tissue can cause acute pain or stinging sensations. This pain may cause people to avoid or delay bowel movements, leading to constipation and further complications.

Discomfort from exposed tissue: When the prolapsed rectum remains outside the body, the exposed tissue can become:

• Dried out and cracked, causing burning sensations
• Swollen and tender to touch
• Painful from friction against clothing
• Increasingly sensitive and irritated over time

Pain when sitting: Sitting can put direct pressure on the prolapsed tissue, causing significant discomfort. Many people find they need to shift positions frequently or use cushions to alleviate the pressure.

In severe cases where the blood supply to the prolapsed tissue becomes compromised (strangulation), the pain can become intense and is considered a medical emergency requiring immediate attention.

7. Difficulty Controlling Gas

Along with fecal incontinence, many people with rectal prolapse experience difficulty controlling the passage of gas, also known as flatus incontinence. This symptom results from the same underlying problem: weakened and stretched anal sphincter muscles that can no longer maintain adequate closure.

The anal sphincter consists of two rings of muscle—the internal and external sphincters—that work together to keep the anus closed until you voluntarily decide to have a bowel movement or pass gas. When rectal prolapse occurs, these muscles become:

• Overstretched from the prolapsing tissue passing through them repeatedly
• Weakened from chronic strain and damage
• Unable to distinguish between gas, liquid, and solid stool
• Impaired in their ability to maintain constant tone and pressure

This leads to involuntary gas passage that can occur:

Without warning: Gas escapes without the person feeling it coming or being able to prevent it, which can be particularly embarrassing in social situations.

During physical activity: Movement, exercise, bending, or lifting can increase abdominal pressure and force gas past the weakened sphincter.

At night: During sleep, when conscious control is relaxed, gas may pass involuntarily.

While gas incontinence may seem like a minor issue compared to fecal incontinence, it can still significantly impact a person’s confidence and social life, causing them to withdraw from activities and social interactions.

What Causes Rectal Prolapse?

Understanding the underlying causes of rectal prolapse can help in both prevention and early recognition of risk factors. Rectal prolapse develops when the tissues and muscles that support the rectum become weakened or damaged. Several factors can contribute to this condition:

Chronic constipation and straining: Repeatedly straining during bowel movements puts excessive pressure on the pelvic floor muscles and rectal tissues, gradually weakening them over time. This is one of the most common contributing factors.

Aging: As people get older, the muscles and ligaments throughout the body naturally weaken, including those supporting the rectum and pelvic organs. This makes rectal prolapse more common in elderly individuals, particularly women over 50.

Pregnancy and childbirth: Multiple vaginal deliveries can weaken the pelvic floor muscles and damage the supporting structures of the rectum, increasing the risk of prolapse later in life.

Chronic cough or respiratory conditions: Conditions that cause persistent coughing, such as chronic obstructive pulmonary disease (COPD) or chronic bronchitis, create repeated increases in abdominal pressure that can contribute to prolapse.

Previous pelvic surgery: Surgical procedures involving the pelvis or rectum can sometimes damage or weaken the supporting structures, making prolapse more likely.

Neurological conditions: Diseases affecting the nerves that control bowel function, such as multiple sclerosis, spinal cord injuries, or stroke, can impair the normal muscle tone and coordination needed to keep the rectum in place.

Connective tissue disorders: Some people have conditions that affect the strength and elasticity of connective tissues throughout the body, making them more susceptible to prolapse.

Chronic diarrhea: While constipation is more commonly associated with prolapse, chronic diarrhea can also contribute by causing repeated straining and irritation.

Malnutrition or poor overall health: Inadequate nutrition can lead to muscle weakness and poor tissue integrity, increasing vulnerability to prolapse.

Prevention Strategies

While not all cases of rectal prolapse can be prevented, especially those related to aging or genetic factors, there are several strategies that can help reduce your risk or prevent the condition from worsening:

Maintain healthy bowel habits:

• Eat a high-fiber diet including fruits, vegetables, and whole grains to promote regular, soft bowel movements
• Drink plenty of water throughout the day to prevent constipation
• Avoid straining during bowel movements—never force or push excessively
• Respond promptly to the urge to have a bowel movement rather than delaying
• Limit time spent sitting on the toilet to reduce unnecessary pressure

Strengthen pelvic floor muscles:

• Practice pelvic floor exercises (Kegel exercises) regularly to maintain muscle tone
• Consider working with a physical therapist specializing in pelvic floor health
• Engage in regular moderate exercise to maintain overall muscle strength

Manage chronic conditions:

• Seek treatment for chronic cough, allergies, or respiratory conditions
• Work with your healthcare provider to manage chronic constipation or diarrhea
• Maintain a healthy weight to reduce pressure on pelvic structures

Use proper lifting techniques:

• Avoid heavy lifting when possible
• Use your legs rather than your back when lifting
• Exhale and avoid holding your breath during lifting to prevent increased abdominal pressure

Seek early medical attention:

• Consult a healthcare provider if you notice any early signs of prolapse
• Don’t ignore symptoms or hope they will resolve on their own
• Early intervention can prevent progression and may allow for less invasive treatment options

Frequently Asked Questions

Can rectal prolapse go away on its own?

No, rectal prolapse does not typically resolve without treatment. In fact, the condition usually worsens over time if left untreated. Early-stage prolapse may be manageable with conservative measures, but most cases eventually require medical intervention to correct the problem and prevent complications.

Is rectal prolapse the same as hemorrhoids?

No, these are different conditions. Hemorrhoids are swollen blood vessels in the anal area, while rectal prolapse involves the actual rectal tissue slipping out of position. Hemorrhoids typically appear as small, grape-like bulges, whereas prolapsed rectum appears as a larger, red, tubular protrusion. However, both conditions can coexist, and a healthcare provider can properly distinguish between them.

Who is most at risk for developing rectal prolapse?

Rectal prolapse is most common in women over 50 years old, particularly those who have had multiple vaginal deliveries. However, it can also occur in young children (usually under age 4), elderly men, and people with chronic constipation, neurological disorders, or conditions affecting connective tissue strength.

Can I push the prolapsed rectum back in myself?

In early stages, the prolapsed tissue may retract on its own or can sometimes be gently pushed back manually. However, you should consult a healthcare provider before attempting this, as improper technique could cause injury. Never force the tissue back if it doesn’t go easily, and seek medical attention if it won’t stay in place or becomes painful and swollen.

How is rectal prolapse diagnosed?

Diagnosis typically involves a physical examination where your doctor will ask you to strain or squat to reproduce the prolapse. Additional tests may include a colonoscopy to rule out other conditions, anal manometry to assess sphincter muscle function, or imaging studies to evaluate the extent of the prolapse and check for other pelvic organ problems.

Will I need surgery for rectal prolapse?

Surgery is the definitive treatment for rectal prolapse and is recommended in most cases, especially when the prolapse is complete or causing significant symptoms. The specific type of surgery depends on various factors including your age, overall health, severity of prolapse, and presence of other pelvic floor disorders. Your healthcare provider will discuss the most appropriate treatment options for your situation.

Can rectal prolapse cause serious complications if untreated?

Yes, untreated rectal prolapse can lead to several complications including ulceration and bleeding of the prolapsed tissue, worsening fecal incontinence, strangulation where blood supply is cut off (a medical emergency), and significant impact on quality of life. Chronic prolapse can also lead to permanent nerve and muscle damage, making future treatment less effective.

Is rectal prolapse common in children?

Rectal prolapse can occur in young children, typically between ages 1 and 4. In children, it’s often associated with chronic constipation, prolonged toilet training, diarrheal illnesses, or conditions like cystic fibrosis. Unlike in adults, childhood rectal prolapse often resolves with conservative treatment addressing the underlying cause, and surgery is rarely necessary.

References:

• Mayo Clinic – Rectal Prolapse
• National Institute of Diabetes and Digestive and Kidney Diseases – Rectal Prolapse
• Johns Hopkins Medicine – Rectal Prolapse
• American Society of Colon and Rectal Surgeons – Rectal Prolapse
• NHS – Rectal Prolapse
• Cleveland Clinic – Rectal Prolapse