Prolapsed Rectum and Bleeding

Man in toilet stall
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Probably the most common sign heralding colon cancer is rectal bleeding, but this symptom can also be caused by another condition called rectal prolapse. When this happens, the last portion of your colon, the rectum, protrudes beyond the anus and is visible on the outside of your body.

With rectal prolapse, you may even be able to feel a small lump or soft piece of tissue extending from your anus. While it's not a comfortable or natural feeling, most people with rectal prolapse state that it does not cause pain.

Note, however, that most abnormal lumps around the anus are hemorrhoids.

Who Gets Rectal Prolapse?

Rectal prolapse is more common in adults and women after childbirth. It is relatively uncommon to see a small child with a prolapse unless it is caused by a congenital malformation of the pelvic floor -- the smooth tissues and muscles that support your rectum. As you age, these muscles lose tone and this can result in a small prolapse. Similarly, after women give birth to children, the muscles can relax and stretch, also setting the stage for a prolapse. Constipation, and the consequential straining to move your bowels, is also a common cause of rectal prolapse.

Signs of a Rectal Prolapse

Aside from noticing the rectal tissue outside of your anus, a prolapsed rectum may cause several other symptoms. If you pass bloody stools, see blood in the toilet bowl after a bowel movement or see blood on the tissue while wiping, do not ignore it.

Rectal bleeding is a sign of colon cancer, but it also has several more innocuous causes including ulcers, gastrointestinal viruses, hemorrhoids or even a prolapse. You should never assume the cause of the bleeding -- see your doctor and discuss it.

You might first notice a prolapse following a coughing or sneezing fit.

If you have a rectal prolapse, the tissues can protrude with the increased pressure from coughing or sneezing and then retract when you are finished.

Diagnosis of Rectal Prolapse

The easiest way to diagnose a rectal prolapse is through a complete physical examination. Your physician will take a history of your complaints and might be able to visualize the rectal tissue extending through your anus. Unlike a hemorrhoid, a rectal prolapse can usually be gently tucked back up inside your rectum. If your doctor has concerns about the severity or underlying cause of your prolapse he or she may send you for further testing.

An evacuation proctogram is a highly specialized radiographic test used to detect and diagnose malformations of your pelvic floor -- the area where your rectum lies. This test is not available in all locations due to the specialized equipment needed and is not frequently done for a routine problem.  

Treating a Prolapsed Rectum

Most often a small rectal prolapse does not require any intervention or treatment, just monitoring.

Making some simple dietary changes can help stop the progression of prolapse. Increasing your fluid and fiber intake will help to decrease the amount of time you spend straining on the toilet to pass a bowel movement. 

In some cases, surgical correction of the prolapse is required. The majority of healthy adults will require general anesthesia for this (you are put to sleep for the surgery by an anesthesiologist). There are several different ways that your surgeon can surgically correct the prolapse, but most techniques involve removing a small portion of your colon and reattaching it to your anus. This is a major surgery that requires a hospitalization; discuss the risks and benefits with your doctor. 

When to Call Your Doctor Immediately 

It is an emergency if you have a known rectal prolapse that stays on the outside of your body. The prolapsed tissue can become strangled and start to lose circulation, and as the tissues lose circulation, they become necrotic and die. This requires serious medical treatment and most likely surgery to correct. 

You should also go to the emergency room any time a rectal prolapse is causing symptoms, such as pain, fever, or a lot of bleeding. If you suspect a rectal prolapse is staying outside your body or have a large prolapse, you should also go to the ER. If the prolapse isn't causing symptoms, make an appointment with your physician.

You should always report any rectal bleeding. The cause might be innocuous, but you won't know until you speak to your doctor. If significant enough, continuous blood loss can cause serious problems.


American Society of Colon and Rectal Surgeons. (n.d.). Rectal Prolapse. Accessed December 16, 2013.

Bowel and Cancer Research. (n.d.). Rectal Prolapse. Accessed December 15, 2013.

Cedars Sinai. (n.d.). Evacuation Proctogram. Accessed December 5, 2015.

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