Rectal prolapse is a condition in which the rectum—the final part of the large intestine—slides downward and protrudes through the anal canal. The prolapse may involve only the inner lining or the full thickness of the rectal wall, so severity can range from a mild protruding sensation to obvious tissue outside the anus. A reddish mass that appears especially during bowel movements is one of the most typical clues. ^[1][3]

This does not always mean emergency surgery, but it should not be dismissed as “just hemorrhoids” for months or years. Rectal prolapse can lead to fecal leakage, constipation, mucus discharge, bleeding, hygiene problems, and substantial impairment in quality of life. In some patients it develops alongside pelvic floor weakness and bowel dysfunction, so the problem needs to be assessed in context rather than as an isolated anatomic finding. ^[1][2][4]

What are the symptoms?

The most common complaint is a soft, reddish mass protruding from the anus, especially after straining. Early on, the tissue may go back in on its own; later, a person may need to push it back manually, or the prolapse may become increasingly persistent. Fecal leakage, a feeling of fullness, incomplete emptying, mucus seepage, and mild bleeding are also common. ^[1][3]

For some people, the dominant symptom is not leakage but chronic constipation and difficult evacuation. As the rectum loses its normal position, stool passage may become mechanically harder, leading to prolonged time on the toilet and repeated straining. Over time, that straining can further worsen the prolapse and create a self-perpetuating cycle. ^[2][4]

If prolapsed tissue remains outside for long periods, irritation, tenderness, and hygiene difficulties may develop. Dark discoloration, severe pain, heavy bleeding, or a firm prolapsed mass that cannot be pushed back in warrant urgent evaluation because they may suggest impaired blood supply or incarcerated prolapse. ^[1][2]

What causes it and who is more likely to develop it?

Rectal prolapse usually does not have a single cause. Age-related tissue laxity, weakness of the pelvic floor and anal sphincter muscles, chronic constipation, years of straining, and certain neurologic or connective tissue disorders can all contribute. It is seen more often in women, especially those with obstetric histories that may have affected the pelvic floor. ^[2][4]

Rectal prolapse can also occur in children, but the causes are not identical to those seen in adults. In children, diarrhea, intestinal infection, congenital conditions, and cystic fibrosis may be considered. In adults, long-standing pelvic floor weakness and defecatory dysfunction are more prominent. ^[3]

The condition may coexist with other pelvic floor disorders such as urinary leakage, uterine prolapse, rectocele, or chronic defecatory dysfunction. That is why evaluation should address bowel habits, incontinence, pelvic floor function, and daily-life impact—not just the protruding tissue itself. ^[2][4]

How is it diagnosed?

The diagnosis is often strongly suspected from the history and physical examination. A clinician asks when the prolapse appears, whether it reduces spontaneously, whether constipation or leakage is present, and whether mucus or bleeding accompanies the problem. During the examination, the patient may be asked to strain because the prolapse can be obvious only under pressure similar to a bowel movement. ^[2][3]

Additional testing may be used to confirm the diagnosis or assess other disorders. Colonoscopy may be considered when bleeding or a concurrent colon problem is suspected. Tests assessing anal sphincter function, pelvic floor motion, or evacuation dynamics can be useful in surgical planning, especially when constipation and incontinence occur together. ^[2][3]

What are the treatment options?

The goals of treatment are to correct the prolapse, improve bowel function, and reduce associated symptoms such as leakage. In adults, definitive treatment is often surgical because established prolapse rarely resolves permanently on its own. Even so, managing constipation, using stool-softening strategies, optimizing fiber and fluid intake, and reducing unnecessary straining remain important before and after surgery. ^[2][4]

The surgical approach is individualized. Abdominal procedures and perineal procedures are chosen according to age, overall health, coexisting disease, and bowel function. Some operations aim to restore and secure the rectum to its normal position, while others remove the lax prolapsing segment. Choosing the best method generally requires colorectal surgical evaluation. ^[2][4]

Surgery is planned not only to correct anatomy but also to improve function. Some patients experience marked improvement in fecal leakage, while others continue to struggle with constipation or may even notice worsening constipation. For that reason, the treatment plan should be based on the patient’s predominant symptoms rather than on anatomy alone. ^[2][4]

Complications and when to seek medical care

Untreated rectal prolapse can become easier to trigger, harder to reduce, and more irritating over time. Chronic mucus leakage, skin irritation, hygiene difficulty, bleeding, and fecal incontinence can substantially affect daily life. Long-standing constipation and excessive straining also worsen the condition. ^[1][2]

Increasing protrusion, darkening of the tissue, sudden severe pain, significant bleeding, fever, or inability to pass stool or gas deserve prompt medical attention. Even in milder cases, repeatedly recurring prolapse deserves specialist evaluation because timely planning usually protects quality of life better than prolonged delay. ^[1][2]

Although it may feel embarrassing, rectal prolapse should not be ignored. Persistent protrusion, leakage, or difficult bowel movements are good reasons to seek evaluation by a general surgeon or colorectal surgeon. ^[2][4]

FAQ

Is rectal prolapse the same thing as hemorrhoids?

No. Hemorrhoids involve vascular cushions in the anus and lower rectum, whereas rectal prolapse involves downward displacement of rectal tissue itself. They can look similar from the outside, but diagnosis and treatment differ. ^[1][3]

Can rectal prolapse go away on its own?

In adults, significant rectal prolapse usually does not resolve permanently without treatment. Symptoms may fluctuate, but the underlying problem often remains. ^[2][4]

Is surgery always necessary?

Not every patient is the same, but surgery is often the definitive treatment in adults. The decision depends on the degree of prolapse, the severity of constipation or incontinence, and overall health status. ^[2][4]

Does rectal prolapse turn into cancer?

Rectal prolapse itself is not considered a disease that directly becomes cancer. However, bleeding, weight loss, new bowel habit changes, or late-onset symptoms may justify evaluation for other causes. ^[2][3]

When is urgent care needed?

If the prolapsed tissue cannot be pushed back in, becomes very painful or dark, bleeds heavily, or is accompanied by fever or inability to pass gas or stool, urgent evaluation is needed. ^[1][2]