Understanding Rectal Prolapse

By Lainie Givens, OTR/L, CPHS

Rectal prolapse is when part of the rectum protrudes out of the anus. This can be painful, distressing, and greatly affect quality of life. This condition is more commonly seen in women, but can also occur in men.

There are 3 types of rectal prolapse:

Internal prolapse: The rectum is prolapsed but has not protruded outside of the anus
Mucosal prolapse: The interior lining of the rectum protrudes through the anus
External prolapse: The entire rectum protrudes through the anus

The cause of rectal prolapse is unknown, but there are known risk factors. You may be at risk if you have a genetic predisposition, history of constipation, strain to have bowel movements, weakened pelvic floor muscles, chronic diarrhea, given birth, hypermobile joints, connective tissue disorders including Ehlers Danlos Syndrome and Marfan syndrome, had a stroke/spinal cord injury, Cystic Fibrosis, or dementia.

Symptoms of rectal prolapse may include:

Fecal incontinence
Feeling a bulge after lifting, coughing or sneezing
Difficulty passing a bowel movement
Rectum protrusion out of the anus
Mucous discharge or blood in the stool
Rectal bleeding
Pain in anus, low abdomen or pelvic floor
Pressure in the rectum
Having to push prolapse back in by hand

While not a symptom of rectal prolapse, many people also report discomfort during sexual intercourse.

Diagnostics

If you are experiencing any of these symptoms or suspect rectal prolapse, it is important to see a medical provider for proper and accurate diagnosis. There are multiple ways rectal prolapse can be diagnosed. These include an X-ray taken during a bowel movement called a Videofecogram, Anorectal manometry where a tube is placed inside the rectum to measure pressure & how well the muscles that control bowel movements work, Colonoscopy where a flexible tube with a camera is placed inside the rectum so the healthcare provider can do a visual exam, or a Barium enema where a contrast solution is placed in the rectum and X-ray pictures are taken. Your doctor also may diagnose by having you squat and strain like you’re trying to have a bowel movement to recreate the prolapse.

Treatments for rectal prolapse may include pelvic floor therapy to retrain muscles, develop appropriate defecation mechanics and educate on pressure management strategies to reduce worsening of the prolapse. An important adjunct to pelvic floor therapy is nutrition therapy. This can support you in having regular bowel movements, softer stool consistency, and reduce excessive straining during defecation. A last treatment option is surgery which may include reattaching the rectum to its original position. This can be done through the abdomen, anus or a combination of the two.

If pelvic therapy or surgery are not accessible, here are some tips and exercises to to reduce symptoms of rectal prolapse:

Lifestyle Tips

Defecation posture
- Use a squatty potty, books or towels to bring knees above hips into a squat-like position
- Try focused belly breathing techniques to reduce excessive straining and time on the toilet
Space out prolonged standing activities during the day if possible, and add in some seated rest breaks
Consider using a bidet, wipes or soft cloths after a bowel movement to reduce anal tissue irritation
Wear looser fitting underwear or pants to allow the skin down there to breathe reducing anorectal tissue irritation, chaffing and pain
If you are experiencing sexual pain, try changing sex positions, using lubricant, and slowing down the speed of thrusting

Exercises

Bridge exercise: Lie on your back, feet flat on the ground. Squeeze your butt muscles while lifting your hips up towards the ceiling
Kegels: Do a pelvic floor contraction as if you are stopping the flow of urine and holding back gas before exertional activities such as lifting, bending, coughing or sneezing
Legs up the wall: Lie with your back flat on the floor and legs vertically up the wall while performing focused belly breathing
Focused belly breathing: Place hands on belly and breathe into the hands and into the belly to balance abdomino-pelvic pressure