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Rectal Prolapse

Clinical Subject Page

Rectal prolapse

Rectal prolapse is the protrusion of the rectal mucosa (mucosal prolapse) or the entire
rectal wall (full-thickness prolapse) through the anal opening

Also called

Rectal Procidentia

ICD-10

K62.3

Specialty

Gastroenterology

Onset

Acute

Reviewed

July 2026

On This Page

Overview

– Mucosal prolapse is more common in children.
– Full-thickness rectal prolapse is more common in adults.
– The hallmark presentation is a painless protruding rectal mass during straining.
– Diagnosis is primarily clinical.
– Full-thickness prolapse usually requires surgical treatment.

Etiology & Risk Factors

– Increased intra-abdominal pressure: Excessive straining, Chronic constipation
– Weakness of the pelvic floor muscles: Advanced age, Multiple pregnancies
– Cystic fibrosis (important risk factor in children)

Pathophysiology

Rectal prolapse occurs when:
– The rectal mucosa alone (mucosal prolapse), or
– The entire rectal wall (full-thickness prolapse)
protrudes through the anal canal due to increased intra-abdominal pressure and/or
pelvic floor weakness.
Stretching of the anal sphincter contributes to fecal incontinence

Clinical Presentation

Symptoms
– Painless rectal mass protruding through the anus
– Initially appears only during defecation
– Early stages: Reduces spontaneously after standing
– Later stages: Requires manual (digital) reduction
– Rarely becomes incarcerated: Painful, Cannot be manually reduced
– Fecal incontinence
– Constipation
– Pruritus ani
– Rectal bleeding

History Taking

Assess for: Painless protruding rectal mass, Occurrence during defecation, Need for
manual reduction, Constipation, Fecal incontinence, Rectal bleeding, Pruritus, Duration
and progression, Symptoms of incarceration (pain and inability to reduce)

Physical Examination

– Examine while the patient squats or strains
– Inspect the prolapsed tissue
– Identify: Radial folds (mucosal prolapse), Concentric folds (full-thickness prolapse)
– Assess for: Solitary rectal ulcer, Anal sphincter weakness, Pelvic floor pathology,
Associated pelvic organ prolapse (Uterine prolapse, Vaginal vault prolapse, Cystocele,
Rectocele)
– Perform digital rectal examination

Investigations

Primary investigation
– Clinical examination (usually sufficient)
If diagnosis is uncertain
– Video defecography: Distinguishes full-thickness prolapse from mucosal prolapse;
Barium paste is placed into the rectum and X-rays are taken during defecation
Before surgical treatment
–Proctoscopy and/or colonoscopy: Excludes rectal neoplasm; A rectal tumor may act as a lead point for rectal intussusception
Additional investigations according to presentation
If rectal ulcer present: Biopsy of the ulcer If fecal incontinence present: Anal sphincter manometry
If pelvic floor weakness suspected: Dynamic pelvic floor MRI
Children: Sweat chloride test to exclude cystic fibrosis

Diagnosis

Rectal prolapse is primarily a clinical diagnosis.
Diagnosis is based on: History, Physical examination while straining, Characteristic
appearance of the prolapsed rectum

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Management

Mucosal prolapse
– Conservative treatment
– Digital reduction
– Injection sclerotherapy


Full-thickness rectal prolapse
– Usually requires surgery
– Surgical approach: Abdominal approach, or Perineal approach
– Choice of procedure is individualized

Complications

– Fecal incontinence
– Chronic constipation
– Solitary rectal ulcer
– Rectal bleeding
– Incarcerated rectal prolapse (painful and irreducible)

Prognosis

– Mucosal prolapse often responds to conservative treatment.
– Full-thickness rectal prolapse generally requires surgical correction.
– Appropriate treatment usually improves symptoms and quality of life.

Key Points / Clinical Pearls

– Rectal prolapse is primarily a clinical diagnosis.
– Examine the patient while squatting or straining.
– Radial folds = Mucosal prolapse.
– Concentric folds = Full-thickness prolapse.
– Use video defecography when the diagnosis is uncertain.
– Perform proctoscopy and/or colonoscopy before surgery.
– Additional investigations depend on associated findings: Rectal ulcer → Biopsy; Fecal
incontinence → Anal manometry; Pelvic floor weakness → Dynamic pelvic MRI; Children
→ Sweat chloride test
– Mucosal prolapse is managed conservatively or with injection sclerotherapy.
– Full-thickness prolapse usually requires surgery.