At a glance
Internal rectal prolapse is one of those conditions that causes real symptoms but produces nothing visible to see. The rectum folds inward on itself during bowel movements, creating a partial blockage. People experience the effects — difficulty emptying, a sense of blockage, and the need to strain — but there is nothing to show for it externally.
This guide explains what internal prolapse feels like, how it is diagnosed, and what management options exist.
What it feels like
People with internal rectal prolapse describe a characteristic set of symptoms:
- Incomplete evacuation: the feeling that you have not fully emptied, even after a bowel movement
- Sense of blockage: something feels like it is in the way during bowel movements
- Straining: needing to push harder than expected
- Multiple attempts: returning to the toilet soon after a bowel movement because of the feeling of incomplete emptying
- Splinting: some people describe needing to apply pressure externally (near the vagina or perineum) to help complete the bowel movement
- Mucus discharge: the folded tissue may produce excess mucus
- Rectal aching or pressure: a dull discomfort in the lower rectum
These symptoms overlap with many other conditions — constipation, pelvic floor dysfunction, hemorrhoids — which is why internal prolapse is often diagnosed late.
Why it is difficult to diagnose
The challenge with internal rectal prolapse is that it only happens during straining. At rest, and during a standard rectal examination, the anatomy looks and feels normal. The prolapse occurs dynamically — when the person bears down.
This means:
- A normal physical examination does not rule it out
- A normal colonoscopy does not rule it out
- It requires a specific test — a defecating proctogram — to see what is happening
Many people describe a frustrating journey of being told that nothing is wrong before the right test is eventually performed.
How it is diagnosed
Defecating proctogram
This is the key investigation. It involves passing a contrast paste (which mimics stool) while being imaged with X-ray or MRI. The imaging shows the internal folding of the rectum in real time.
People describe the test as:
- Awkward — having a bowel movement in a medical setting is not comfortable
- Informative — finally seeing what is causing their symptoms is often a significant relief
- Brief — the actual imaging takes only a few minutes
Other investigations
- MRI of the pelvis: may show structural issues at rest
- Anorectal physiology: measures pressures and function
- Flexible sigmoidoscopy: to rule out other rectal pathology
Management
Conservative approaches
For mild to moderate internal prolapse, management often starts with:
- Treating constipation: fibre, adequate fluids, stool softeners — reducing the need to strain removes the force that drives the prolapse
- Pelvic floor rehabilitation: physiotherapy targeting the muscles that support the rectum
- Biofeedback: learning to coordinate the muscles involved in defecation more effectively
- Avoiding straining: easier said than done, but it is the most important behavioural change
When surgery is considered
Surgery may be discussed when:
- Conservative measures have not improved symptoms
- The prolapse is worsening
- Quality of life is significantly affected
Surgical options vary and depend on the specific anatomy and the surgeon’s assessment. The decision is usually made after thorough investigation and a trial of conservative management.
The emotional dimension
People with internal rectal prolapse often describe a specific frustration: having real symptoms that nobody can see. The invisible nature of the condition can make people feel that they are not being taken seriously, or that the problem is in their head.
Being diagnosed — having the imaging that shows the prolapse — is often described as a turning point. Not because the treatment is immediately different, but because having a name and a visible cause for the symptoms provides validation.