Rectal prolapse refers to a condition where part of the wall of of the rectum prolapses (falls down) from their normal anatomical position. The term rectal prolapse often is used synonymously with complete rectal prolapse (external rectal prolapse), where the rectal walls have prolapsed to a degree where they protrude out the anus and are visible outside the body.  This may occur during with straining to defecate, or occur at rest.
Prolapses may involve the full thickness of the rectal wall, or the rectal mucosa only (mucosal prolapse). They may be external (complete) if they protrude from the anus and are visible externally, or internal if they do not protrude externally. There are 3 main conditions which come under the title rectal prolapse:
- Complete rectal prolapse (also termed procidentia, full thickness rectal prolapse, external rectal prolapse) is the circumferential protrusion through the anus of all layers of the rectal wall.  
The term intussusception refers to invagination, or infolding. When the term "intussusception" is used by itself, this usually refers to a condition where one segment of the intestine (or bowel) folds within another. This can be a medical emergency, in contrast with rectal intussusception which is not life threatening. Rectal intussusception refers to the prolapsed section of bowel folding back on itself.
- Mucosal prolapse describes only the rectal mucosa (not the full thickness of the rectal wall) prolapsing.  The term mucosal prolapse usually refers to an external prolapse (i.e. protruding from the anus), but internal mucosal prolapse is possible.
- Internal intussusception (occult prolapse, internal prolapse) is where the rectum collapses but does not exit the anus.
. full thickness external rectal prolapse, and B
. mucosal prolapse
. Note circumferential arrangement of folds in full thickness prolapse compared to radial folds in mucosal prolapse.
A group of conditions known as "Mucosal prolapse syndrome" (MPS) has now been recognized. It includes solitary rectal ulcer syndrome, rectal prolapse, proctitis cystica profunda, and inflammatory polyps. It is classified as a chronic benign inflammatory disorder. The unifying feature is varying degrees of rectal prolapse, whether internal intussusception (occult prolapse) or external prolapse.
Rectal prolapse is caused by the weakening of the ligaments and muscles that hold the rectum in place. In most people, the anal sphincter is weak. Rectal prolapse may occur due to the following causes: long-term anal penetration, long-term constipation, long-term straining during defecation, long term diarrhea, high gastrointestinal helminth loads (e.g. Whipworm), pregnancy and stresses of child-birth, previous surgery, cystic fibrosis, C.O.P.D., and sphincter paralysis.
The condition of rectal prolapse, a type of rectal rupture, undergoes progression, beginning with prolapsation during bowel movements, through Valsalva maneuvers (sneezing and so forth), then through daily activities such as walking until finally it may become chronic and ceases to retract.
Partial prolapse may be treated by a diet high in fiber.
Pharmaceutically, the condition may only be treated secondarily (by treating constipation) so as to avoid further straining.
The alternative is surgery. It may be divided into two forms of procedure: abdominal surgery and perineal surgery.
- Abdominal surgery - for younger patients, but is more dangerous
- Perineal surgery - often performed on older patients and is less dangerous
- Delorme mucosal sleeve resection, which involves rectopexy in the sacral hollow or to the promontory with a synthetic material
- Altemeier perineal rectosigmoidectomy
- Children are treated with linear cauterization
- Manchester operation is used for combined pelvic prolapse.
Recently, robotic-assisted surgery has been introduced as a treatment option.
Because most sufferers are elderly, the condition is generally under-reported. The condition can also occur in children.
Deliberate prolapse ("rosebud")
This is a prolapse which occurs as a result of intentional dilatation of the anal sphincter for sexual gratification. The colloquial term for the prolapse which results intentionally during sexual activity is a "rosebud". This is a type of sexual fetishism and is associated with 'fisting' and 'anal stretching' - insertion of the hand into the rectum or dilatation of the anus with sexual aids.
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