Rectal prolapse

Last updated: December 27, 2021

Summarytoggle arrow icon

Rectal prolapse is the protrusion of rectal mucosa (mucosal prolapse) or the entire rectum (full-thickness prolapse) through the anal opening. While mucosal prolapse is more common in children, full-thickness prolapse occurs more commonly in adults. Increased intra-abdominal pressure (e.g., excessive straining as a result of constipation) and weakness of the pelvic floor muscles (e.g., as a result of old age, multiple pregnancies) are risk factors for rectal prolapse. Cystic fibrosis, moreover, is an important risk factor in children. The most commonly presenting complaint is a painless rectal mass that appears on straining. Other symptoms include fecal incontinence and/or constipation and pruritus ani. Inspection of the prolapsed structure helps to determine the type: In partial prolapse, radial folds are typically present in the mucosa, while a complete prolapse exhibits concentric mucosal folds. If clinical examination does not reveal any significant findings, video defecography may be used to confirm the diagnosis. Mucosal prolapse can be treated conservatively with digital reduction or injection sclerotherapy. Full-thickness prolapse, on the other hand, usually requires surgery. Surgery for full-thickness prolapse may be conducted either using an abdominal or a perineal approach, usually determined on a case-by-case basis.

Epidemiologytoggle arrow icon

  • Age of onset: bimodal incidence
    • Adults
      • : < 40 years
      • : 60–70 years
    • Children: < 3 years
  • Sex


Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon


Pathophysiologytoggle arrow icon

Depending on the severity of the rectal prolapse, rectal prolapse may be classified as:

  • Mucosal prolapse (partial prolapse)
    • Protrusion of the rectal mucosa through the anus
    • Typically less than 4 cm in length
    • Much more common in children and infants
  • Full-thickness prolapse (complete prolapse)
    • Usually begins as a rectal intussusception; therefore, all layers of the rectal wall protrude through the anus.
    • > 4 cm in length (usually 10–15 cm long when fully prolapsed)
    • Much more common in adults


Clinical featurestoggle arrow icon


Physical examination

The perineum should ideally be examined while the patient squats or strains.


Diagnosticstoggle arrow icon


Treatmenttoggle arrow icon

Mucosal prolapse

Full-thickness rectal prolapse

Full-thickness prolapse requires surgical treatment with either an abdominal or perineal approach.

  • Abdominal procedures: laparoscopic rectopexy with/without sigmoidectomy
  • Perineal procedures
    • Short, full-thickness prolapse: Delorme procedure
    • Long, full-thickness prolapse that cannot be treated by abdominal procedures: Altemeier procedure (perineal rectosigmoidectomy)

While surgery is performed electively in most cases, incarcerated rectal prolapse should be treated as a surgical emergency!

In addition to definitive management of rectal prolapse, any underlying risk factors (e.g., constipation) must be addressed in order to prevent recurrence.

Referencestoggle arrow icon

  1. Williams NS, Bulstrode C, O'Connell PR. Bailey & Love's Short Practice of Surgery. CRC Press ; 2013
  2. Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Elsevier ; 2016
  3. Zempsky WT, Rosenstein BJ. The cause of rectal prolapse in children. Am J Dis Child. 1988; 142 (3): p.338-339.
  4. Stern RC, Izant RJ, Boat TF, Wood RE, Matthews LW, Doershuk CF. Treatment and prognosis of rectal prolapse in cystic fibrosis. Gastroenterology. 1982; 82 (4): p.707-710.
  5. Varma M, Rafferty J, Buie WD. Practice parameters for the management of rectal prolapse. Dis Colon Rectum. 2011; 54 (11): p.1339-1346.doi: 10.1097/DCR.0b013e3182310f75 . | Open in Read by QxMD
  6. Siafakas C, Vottler TP, Andersen JM. Rectal prolapse in pediatrics. Clin Pediatr. 1999; 38 (2): p.63-72.doi: 10.1177/000992289903800201 . | Open in Read by QxMD
  7. Madiba TE. Surgical management of rectal prolapse. Arch Surg. 2005; 140 (1): p.63.doi: 10.1001/archsurg.140.1.63 . | Open in Read by QxMD
  8. Cystic Fibrosis Symptoms and Treatment. Updated: February 23, 2017. Accessed: February 23, 2017.

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