If this sounds familiar — to you, or to someone you're caring for — what she was describing is a condition called rectal prolapse. It's understandably embarrassing to bring up, but it's also common, well understood, and very treatable.
What is rectal prolapse?
The rectum is the last segment of the large intestine, sitting just before the anus — the muscular opening through which stool leaves the body. In rectal prolapse, the rectum loses its normal support and slips downward, partly or fully protruding through the anus.
It can look alarming and cause real discomfort, but importantly, it is not a medical emergency in most cases, and it is treatable. The bigger challenge for many patients is simply working up the courage to talk about it.
What increases the risk?
Rectal prolapse happens when the muscles and supporting tissue that normally hold the rectum in place weaken over time. Several factors make this more likely:
Gender
Women are considerably more prone to rectal prolapse, partly due to anatomical differences and the effects of childbirth on pelvic support structures.
Age
Most common after age 50, as the muscles and ligaments supporting the pelvic floor naturally weaken over time.
Chronic constipation
Years of straining during bowel movements puts repeated pressure on the structures that hold the rectum in place.
Childbirth
Vaginal delivery can weaken the pelvic floor, contributing to prolapse risk later in life.
Neurological conditions
Spinal cord injury or a history of stroke can impair the nerves and muscles that support the lower bowel.
Signs and symptoms to watch for
- A reddish bulge at the anus, especially when straining, coughing, sneezing, or lifting — sometimes it retracts on its own, sometimes it doesn't
- Mucus in the stool
- A persistent feeling of incomplete bowel emptying
- Abdominal cramping or general discomfort
- Rectal bleeding from irritation of the prolapsed tissue
- Changes in bowel habits — constipation, looser stools, or alternating between the two
- Pain, irritation, or itching around the anus
How is it diagnosed?
Rectal prolapse can sometimes be mistaken for haemorrhoids, since the symptoms overlap considerably. Getting the diagnosis right matters, because the treatment approach differs.
Your doctor will start with a detailed history and a physical examination, then may recommend further tests depending on what's found:
Defecogram
An imaging study (X-ray or MRI) taken while you have a bowel movement, helping visualise exactly what's happening with the muscles and structures around the rectum.
Colonoscopy
Examines the entire large bowel to rule out other causes such as polyps, cancer, or haemorrhoids. Performed under sedation, so it's painless.
Anal manometry
A small probe assesses how well the sphincter muscle and surrounding tissue function during a bowel movement.
Pelvic floor evaluation
Depending on individual risk factors, additional urological or gynaecological assessment may be recommended to check for related pelvic floor weakness.
What can go wrong if left untreated?
- A prolapse that can't be gently pushed back in risks cutting off blood supply to that section of bowel — a genuine emergency requiring urgent care
- Prolonged prolapse can lead to bleeding and ulceration of the exposed tissue
- Ongoing pain and discomfort that interferes with daily activities
- Real impact on quality of life — difficulty controlling bowel habits and persistent self-consciousness about the bulge
Seek urgent care if: a prolapse cannot be gently pushed back in, becomes increasingly painful, or changes colour — these can signal strangulation, which needs emergency treatment.
Treatment options
Treatment is tailored to the individual — taking into account age, gender, overall health, and how much the condition is affecting daily life.
If chronic constipation is the underlying driver, the first step is addressing that directly: more dietary fibre, adequate fluids, and sometimes stool softeners or suppositories to reduce straining. For more significant prolapse, surgery becomes the most effective long-term solution.
Abdominal repair
The rectum is repositioned through a small abdominal incision and secured in place, sometimes with a mesh sling, anchoring it to the sacrum. In cases of chronic constipation, a portion of redundant colon may also be removed.
Recurrence rate: under 10% — one of the most durable surgical options available.
Laparoscopic repair
The same repair achieved through several small keyhole incisions rather than one larger cut — lower complication risk, less pain, and a shorter hospital stay compared to open surgery.
Robotic repair
A further refinement of the laparoscopic approach, using robotic-assisted instruments for enhanced precision — particularly valuable for more complex pelvic anatomy.
The most important step is the first conversation. Rectal prolapse is genuinely common, especially as we age, and there's no need to manage it in silence. The earlier it's addressed, the simpler and more effective treatment tends to be.
Dr Cha Kar Huei
Consultant General Surgeon (Gastrointestinal, Bariatric & Robotic Surgery), Hospital Picaso