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Rectal Prolapse is a condition when the rectum as a wide and soft walled tube turns into itself and falls out through the anal opening. If it happens in a sudden way and does not reverse itself it might need an emergency surgery. Most of the time however it happens gradually and reversibly, so it falls out after passing some stool and reuters back to its place some time after defecation is finished.

Often the prolapse of the rectum into itself is not complete and it does not fall through the anus only invaginate into itself within the rectum: this is called Internal Rectal Intussusception.

Either way the rectal wall doubling, tripling up inside its own lumen causes obstructed defecation type of constipation with difficulties on the toilet. Early cases can benefit a lot from physiotherapy and dietary changes. Advanced cases need surgery.

What signs and symptoms one has with this problem?

With a full thickness rectal prolapse, patient notices a bulge, as big as an apple or longer, coming down through the anus which remains outside or the anus after passing the stool. It is darker or lighter pink with a shiny wet surface, because it is the mucus membrane lining of the rectum coming visible outside. It is not painful unless it gets stuck outside, in which case it turns purple and needs an emergency surgery to fix it. Often patients learn to put it back through the anus, where it stays then until the next bowel movement.

Rectal prolapse often mistaken for circumferential hemorrhoidal prolapse, which is however covered with anal skin and not mucus membrane and is not one bulge but rather several swollen “petals”. It can also present purple, but it is not a surgical emergency.

Internal rectal intussusception is not so obvious for the patient. With this condition the main symptom is obstructed defecation, which is difficulty emptying the bowel when the urge comes. The urge is generated by the doubled up rectal segment, eventually, after long straining, stool empties but the patient still feels as if something is left inside (feeling of incomplete evacuation).

Normal Pelvis

Intra-Rectal Intussusception

Rectal Prolapse