Rectal prolapse: causes, symptoms, and treatment options

Rectal prolapse is a condition where your rectum shifts down inside your anus. If you suspect that you are dealing with rectal prolapse, you might not be sure where to turn for help. It’s understandable if you feel hesitant to bring up your symptoms – they can feel personal and uncomfortable to discuss. But this is something your doctor is equipped to help with.

Rectal prolapse symptoms may make you feel self-conscious, but there's a lot you can do when it comes to rectal prolapse treatment, reassures Ken McGee, PT, DPT, a physical therapist with Hinge Health. "Pelvic floor strengthening can help manage the symptoms of rectal prolapse, and it may also prevent prolapse from happening," he says. While rectal prolapse may require surgery, mild cases can be treated conservatively with targeted exercises, physical therapy, and lifestyle modifications.

What is rectal prolapse?

Rectal prolapse occurs when the support structures around your anus and rectum become less rigid, allowing the rectum lining to slip down. There are three main types:

• Complete (full thickness) rectal prolapse. The entire wall of your rectum protrudes through your anus.

• Mucosal prolapse. Only the inner lining of your rectum protrudes.

• Internal prolapse (internal intussusception). Your rectum starts to collapse but doesn't come out through your anus yet.

“Not everyone with rectal prolapse can get surgery right away,” says Dr. McGee. “Pelvic floor physical therapy can help people understand how to manage symptoms in the meantime, as well as how to optimize recovery from a surgical procedure.”

Symptoms of rectal prolapse

Rectal prolapse symptoms can come on gradually or suddenly. "The most common complaint from my patients is that it feels like something is coming out of their anus," says Dr. McGee. It may initially only happen when you have a bowel movement, but can progress to whenever you cough, sneeze, or even walk. 

You may also notice the following:

• A sensation of fullness or pressure around your anus.

• A feeling of sitting on a ball.

• Difficulty with bowel movements. You may notice that it's hard to control bowel movements, or, on the flip side, once you have one you still don't feel completely "empty."

• Pain or discomfort around your anus.

• Mucus or blood discharge from your rectum.

While symptoms can progress over time, early intervention with strengthening exercises and lifestyle changes can help manage them effectively.

Rectal prolapse vs. hemorrhoids

Rectal prolapse can often be confused with hemorrhoids, because they may look and feel similar. But they're quite different. “They share common risk factors, like recurrent straining, and they both can cause inflamed tissue to protrude from the anus," explains Dr. McGee.

Here are some key differences: 

Rectal prolapse

• A ring of your rectum protrudes downward into your anus.

• Appears as a large red moist mass with circular folds

• Can be anywhere from a quarter inch to muscle inches

• Sometimes requires surgery

Hemorrhoids

• Due to swollen blood vessels in your anal area

• Often appears as smaller, purplish lumps

• Can often be managed with conservative therapies like treating constipation, and over-the-counter remedies

• Less likely to require surgery

It can be hard to tell whether symptoms are due to a rectal prolapse or a hemorrhoidal prolapse. Your healthcare provider can diagnose your prolapse with a physical exam.

Causes of rectal prolapse

Rectal prolapse happens when the muscles and connective tissue that support your rectum change, causing your rectum to slip out of position. Common contributing factors include:

• Changes in pelvic floor function. "The muscles and connective tissue that support your rectum can lose elasticity with age," explains Dr. McGee. Women over the age of 50 are most at risk. However, rectal prolapse can affect anyone — including men — especially with age or chronic straining. "The good news is pelvic floor function is something you can improve," he adds. "You can build strength and support through targeted exercise."

• Chronic straining. Frequent constipation can challenge the capacity of your anal sphincter muscles over time, which support your rectum.

• History of childbirth. Vaginal deliveries can temporarily reduce the function of pelvic floor muscles, though many people recover well with appropriate strengthening.

• Chronic conditions. Chronic coughing from COPD or bronchitis can put more demand on pelvic floor ligaments and muscles. Neurological conditions like multiple sclerosis, spinal cord injury, or Parkinson's disease can also affect nerves in the area.

• Previous pelvic surgery. Surgery can temporarily affect surrounding pelvic floor muscles.

How movement can help rectal prolapse

Like many other conditions, movement is medicine when it comes to rectal prolapse. "A lot of my patients are concerned that exercise will make it worse, but that's not always the case," reassures Dr. McGee. Pelvic floor physical therapy is especially important, since it builds the capacity of the muscles that support your rectum and can help address the factors that contributed to the prolapse.

Most people with rectal prolapse find low impact activity such as walking, biking or swimming most comfortable, adds Dr. McGee. Targeted pelvic floor exercises, like the ones listed below, are also key. "Depending on your specific circumstances, exercise alone may not be able to reverse prolapse. But research shows that pelvic floor exercises for prolapse can help prevent progression," says Dr. McGee. These exercises will also be important to help you recover if you do require surgery.

These pelvic floor exercises for prolapse strengthen supporting muscles, can help slow progression, and are crucial for preventing recurrence if you do need to have surgery. Kegels strengthen your pelvic floor muscles, including your anal sphincter muscle, to better support your rectum. Bridges, clam shells and straight leg raises all build hip strength, to support your pelvic floor. Diaphragmatic breathing relieves stress and lengthens your pelvic floor muscles, which makes them more flexible so they can better support your rectum.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for rectal prolapse

Rectal prolapse treatments depend on severity. If your symptoms are mild, you may just need pelvic floor exercises and lifestyle changes. Complete rectal prolapse almost always requires surgery. However, people who cannot tolerate surgery may be referred to physical therapy. 

While your doctor can help recommend the best path forward for your specific case, here’s what Hinge Health physical therapists generally recommend:

• Try physical therapy and targeted exercises. "A physical therapist can help you fine-tune techniques for pelvic floor muscle exercises to make sure you do them properly," explains Dr. McGee. They can also teach you strategies to help manage any discomfort.

• Stay active. Regular aerobic exercise helps to support overall health and build your body’s capacity. "Even just walking for thirty minutes daily will help to support pelvic floor health," adds Dr. McGee.

• Address constipation and straining. A high-fiber diet and regular exercise can help to prevent both. "I also recommend deep breathing exercises like diaphragmatic breathing when you have a bowel movement. Some people benefit from a technique called perineal splinting, which involves placing a hand in front of the anus and pressing up towards the head in order to stabilize the anus for easier emptying.”

• Surgical repair. If you have a complete rectal prolapse, or if the above treatments don't help, your doctor may recommend surgery. The most common operation is rectopexy, where your rectum is returned to its original position. You'll most likely benefit from physical therapy after surgery.

How to prevent rectal prolapse

While you can't always prevent rectal prolapse, the following can help you reduce risk:

• Strengthen your pelvic floor muscles. The targeted exercises listed above help maintain the support structures that hold your rectum in place. These are especially important before and after childbirth, when big hormonal shifts and physical demands affect connective tissue integrity.

• Prevent constipation. Eat a high-fiber diet, drink plenty of water, and stay physically active. Dr. McGee also recommends elevating your feet using a step-stool or footstool to reduce straining during bowel movements.

• Practice proper lifting techniques. Engage your core muscles when lifting heavy objects, advises Dr. McGee. Your body is designed to lift, but building up gradually helps.

• Treat chronic cough promptly. Conditions like COPD or chronic bronchitis should be managed to reduce the repeated strain on the pelvic floor that comes from coughing.

When to see a doctor

You should always see a doctor if you notice symptoms of rectal prolapse, says Dr. McGee. These include:

• Tissue that sticks out of your anus

• Chronic constipation

• Fecal incontinence (not being able to control your bowel movements)

• Persistent feeling of rectal fullness or pressure

You should get immediate medical attention for rectal prolapse if:

• You can't push prolapsed tissue back in

• You develop severe pain and/or heavy bleeding

• You suddenly can't have bowel movements

Can rectal prolapse fix itself?

A rectal prolapse generally doesn't resolve on its own. "Some mild ones do improve over time, especially if they occur after childbirth and you follow it up with pelvic floor strengthening," says Dr. McGee. But larger ones and complete rectal prolapses tend to progress over time without treatment.

If you have symptoms of rectal prolapse, see your doctor as soon as possible. "They can send you to physical therapy, where you can work on pelvic floor strengthening and address contributing factors like constipation, so your prolapse doesn't progress," says Dr. McGee. "Oftentimes the earlier the intervention, the better the outcome."

PT tip: Blow out as you lift

If you need to lift something heavy, try this simple breathing technique: blow out through pursed lips as you pick the object up. "The movement of air out of your mouth takes pressure off of your pelvic floor," says Dr. McGee. "It's a way to engage your core while reducing the demand on your pelvic floor muscles during the lift."

This technique works because exhaling through pursed lips activates your deep core muscles, which stabilizes the back and pelvic floor. It's especially helpful if you're prone to bearing down or holding your breath when you lift, which can put extra strain on your pelvic floor.

You can use this strategy not just for heavy lifting, but anytime you need to do something that requires effort — like getting up from a low chair, carrying groceries, or picking up a child.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Goldstein, S. D., & Maxwell, P. J. (2011). Rectal prolapse. Clinics in Colon and Rectal Surgery, 24(1), 39-45. doi:10.1055/s-0031-1272822

2. Hamahata, Y., Akagi, K., Maeda, T., Nemoto, K., & Koike, J. (2022). Management of pelvic organ prolapse (POP) and rectal prolapse. Journal of the Anus, Rectum and Colon, 6(2), 83-91. doi:10.23922/jarc.2020-007

3. National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Hemorrhoids.  https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids

4. National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Constipation.  https://www.niddk.nih.gov/health-information/digestive-diseases/constipation

5. National Institute of Diabetes and Digestive and Kidney Diseases. (2019). Rectal prolapse.  https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract/rectal-prolapse

6. Oruç, M., & Erol, T. (2023). Current diagnostic tools and treatment modalities for rectal prolapse. World Journal of Clinical Cases, 11(16), 3680-3693. doi:10.12998/wjcc.v11.i16.3680

7. Wu, L., et al. (2025). Surgical approaches for complete rectal prolapse. World Journal of Gastrointestinal Surgery, 17(3), 102043. doi:10.4240/wjgs.v17.i3.102043