Rectal Prolapse Exercises and Bowel Emptying Technique to Avoid Rectal Prolapse Worsening

Rectal prolapse exercises and using the correct physiotherapy bowel emptying technique can help you manage and potentially reduce the risk of your rectal prolapse worsening.

This Physiotherapy video and information teaches you:

  • Basics for understanding rectal prolapse
  • Common signs and symptoms
  • How to do rectal prolapse exercises (step by step)
  • Bowel management for rectal prolapse

What is a Rectal Prolapse?

Rectal prolapse is a condition where the inside of the rectum protrudes out from within the anus.

During the early stages the prolapse may be pushed back inside the body however if your rectal prolapse stays protruding outside the anus you need to seek urgent medical care which usually involves surgery. 

If you suspect you have a rectal prolapse see your doctor or pelvic floor physiotherapist for assessment and management advice.

3 Types of Rectal Prolapse

rectal prolapse

Mucosal prolapse which involves the rectal mucosa (membrane) protruding through the anus (shown right). This is the type of prolapse for which rectal prolapse exercises may be beneficial.

Full thickness rectal prolapse where the rectal wall protrudes or bulges out from the anus.

Internal intussusception where the rectum collapses but stays inside the body and does not protrude. Rectal prolapse exercises will NOT help this condition.

Rectal prolapse is different to a rectocele however the two conditions are often confused with each other. A rectocele is a pelvic prolapse condition in women where the rectum bulges into the back wall of the vagina. 

What Causes a Rectal Prolapse?

A rectal prolapse results when the supportive tissues that hold the rectum in position become weakened and stretched so they stop working effectively. These tissues include the pelvic floor muscles that act like a supportive hammock.

Pregnancy and rectal prolapse

The common causes of rectal prolapse include:

  • Ageing
  • Chronic constipation and straining to empty the bowel
  • Chronic diarrhoea
  • Pregnancy and childbirth
  • Anal intercourse
  • Cystic fibrosis

Signs and Symptoms of Rectal Prolapse

Signs and symptoms of a rectal prolapse can include:

  • Rectal prolapse signsA red protrusion or bulge come out of the anus especially after a bowel movement (shown right)
  • The bulge may become more obvious with squatting and heavy lifting
  • Mucous and/or bloody discharge from the anus
  • Stained underwear and difficulty cleaning the anus
  • Difficulty emptying the bowel completely and possibly feeling a need to strain to empty
  • General pain or discomfort around the anus which is often worse after activity and/or towards the end of the day.

Initially the rectal prolapse may retract (move back inside) the anus after a bowel movement. 

As rectal prolapse worsens the prolapsed tissue usually becomes more obvious with everyday activities such as walking and prolonged standing. The prolapse may not retract inside the anus and this is a medical emergency.

How to do Rectal Prolapse Exercises

Your pelvic floor is a structure made up of pelvic floor muscles and tissues that suspend your rectum and keep it in the correct position. Some of these muscles also help maintain bowel control.

Rectal prolapse exercises are also known as pelvic floor exercises or Kegels.

Training involves 3 stages or progression. Working through these 3 stages will help you train effectively to achieve your best possible pelvic floor strength and internal support for your prolapse.

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Stage 1 – Starting rectal prolapse exercises

To start your exercises:

  • Seated rectal prolapse exercisesStart sitting upright in a firm backed chair or lying down with your knees bent and feet flat on the ground or on your side.
  • Imagine you are trying to stop wind from passing from your bowel, and urine passing from the urethra (urine tube)
  • Slowly squeeze inside and lift inwards using the muscles in and around the anus and urethra
  • You should be able to see your anus pucker (i.e. close slightly) as you contract and look with a mirror
  • Keep breathing normally and try to keep your buttocks and thighs relaxed during this exercise
  • Relax your pelvic floor muscles and rest briefly before doing your next exercise.

Stage 2 – Exercising your pelvic floor muscles

  • Position yourself where you can best feel your pelvic floor muscles working (lying, sitting or standing)
  • Do each exercise for up to 10 seconds 
  • Relax your pelvic floor muscles in between each exercise and rest briefly to recover
  • Repeat your pelvic floor exercises up to 10 times in a row
  • Next practice lifting and squeezing your pelvic floor muscles with a brisk strong technique for up to 10 times
  • Try to repeat these exercises (long and short muscle holds) 3 times every day

To progress your rectal prolapse exercises:

  • Increase how long you keep your muscles contracted
  • Do stronger contractions using the correct technique
  • Practice your exercises in upright positions (i.e. sitting and standing).

Progressing your exercises is important for making your pelvic floor muscles work harder and ultimately getting the maximum benefit from your training. Your initial focus should be on doing the exercise technique correctly and progressing only when you’re sure you have mastered this.

Stage 3 – Training for everyday

Training for everyday activities involves using your pelvic floor muscles when you need them to work. This includes

  • In upright positions
  • Before and during coughing, sneezing and lifting
  • When you sense an urgency to empty your bowel and also when you need to defer or delay the urge to empty your bladder or bowel.

Tips for Successful Rectal Prolapse Exercises

  • When starting out choose positions such as lying down for your pelvic floor exercises where your prolapse is more supported
  • Focus on using the correct pelvic floor exercise (kegel) technique before progressing your training
  • Perform your pelvic floor exercises (kegels) when your muscles are less likely to be tired (e.g. early in the day)
  • Contract your pelvic floor muscles after using your bowels
  • Progress your pelvic floor exercises into upright standing when you are able to do so.

Bowel Management to Avoid Rectal Prolapse Worsening

Bowel management to avoid rectal prolapse worsening involves managing 2 key aspects to reduce the need to strain:

  • Correcting your stool consistency
  • Using the correct position and technique for bowel emptying

How to Correct your Stool Consistency

Straining is a key reason for rectal prolapse worsening. 

The first step to avoid straining when emptying your bowel is by keeping your stool soft and well formed just like a Type 3-4 on this Bristol Stool Chart (see below). Having a stool consistency that is too loose (i.e. Type 7) or too hard (i.e. Type 1-2) can cause straining with bowel emptying.

Bristol Stool Chart

Problem 1: Stool too Hard

Your stool is too hard (e.g. Type 1-2 consistency) which can cause straining and constipation.

Strategies to soften your stool:

  • Use an osmotic laxative with stool softener like Movicol or Gavilax 
  • Include stool softener foods in your diet
  • Drink adequate fluid
  • Avoid consuming too much fibre if you are already constipated

Problem 2: Stool too Loose

Your stool is too loose (e.g. Type 7) which can can cause you to strain and have bowel leakage bowel leakage.

Strategies to firm your stool and tips for management:

  • Use medication to firm your stool form the pharmacy e.g. Imodium, Lomotil
  • Minimize your intake of bowel irritants like spicy foods or caffeine
  • Barrier cream around anus eg zinc cream (show) protect the skin
  • Psyllium husks 1-2 teaspoons can help soften and mop up any loose stool and reduce the likelihood of leakage
  • Use a plain eye makeup removal pad barrier for odour and leakage
  • Alcohol–free moist wipes or towelettes can assist cleaning and make your last wipe a moist one

Correct Position and Technique for Bowel Emptying

Straining to empty your bowels usually involves pushing or bearing down through the anus, breath holding and pulling your tummy muscles inwards. Pulling in the belly tightens the circular muscle around your anus. Doing this closes the anus making you more likely to need to strain to empty and worsen your rectal prolapse. 

The correct bowel emptying technique with a rectal prolapse:

  • Position your body in preparation for emptying by leaning forward keeping the inward curve in your lower back and your spine lengthened, both feet flat on the ground, hips wide apart and supporting your upper body by resting your hands on your thighs (demonstrated in the video above)
  • To start emptying relax your breathing with 5-6 deep breaths into your belly and allow your belly and pelvic floor muscles to relax
  • Make waist wide by saying “M” sound and then bulge your belly forwards at the same time by saying “oo” to keep your anal sphincter relaxed during emptying
  • Try not to push down through your anus, or pull your belly inwards which increases strain on the rectum
  • Lift and squeeze your pelvic floor muscles when you’ve completed bowel emptying

How to Reduce the Risk of Rectal Prolapse Worsening

  • Do your rectal prolapse exercises daily and gradually progress your exercises when you can
  • Practice good bowel habits using the correct technique for bowel emptying and never strain with bowel movements
  • Choose supported positions wherever possible (for example sitting is more supportive than standing)
  • Spread out your activities during the day, take time to rest and elevate your legs in the afternoon to reduce pressure on your pelvic floor if you have time
  • Avoid heavy lifting which increases pressure on your pelvic floor
  • Manage your body weight and try to avoid unnecessary abdominal weight gain which can increase the load on your pelvic floor.

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References

1. Padda BS, Jung SA, Pretorius D, Nager CW, Den-Boer D, Mittal RK. Effects of pelvic floor muscle contraction on anal canal pressure. Am J Physiol Gastrointest Liver Physiol. 2007 Feb;292(2):G565-71. doi: 10.1152/ajpgi.00250.2006. Epub 2006 Oct 5. PMID: 17023551.

2. Image pelvic floor muscles and rectum attribution: Armin Kubelbeck, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commonshttps://commons.wikimedia.org/wiki/File:Anatomy_of_human_rectum_and_anus-2.png. Image modified to exclude specific labelling and pelvic floor muscle labelling simplified.

3. Image rectal prolapse Credit: St Bartholomew’s Hospital Archives & Museum, Wellcome Images. Wellcome Images [email protected] http://wellcomeimages.org Watercolour drawing probably showing a prolapse of the rectum. 6 Jul 1894 By: Mark, Leonard PortalSt Bartholomew’s Hospital Archives & Museum Published: Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0https://commons.wikimedia.org/wiki/File:Prolapse_of_the_rectum_Wellcome_L0061308.jpg

Comments

  1. I am 97 and have been physically active all my life. I now have rectal prolapse and at times I am somewhat incontinent. Should I continue to walk for exercise or does it exasperate the condition.?

  2. Hi Michelle,

    Is it possible to have full thickness rectal prolapse as well as rectocele? Thank you

  3. Hi Alice,
    I always have an issue with regards to bowel movement since on my teens. I am now a 45 year old lady and has a rectal prolapse issue (I just push it back after bowel movement) My doctor did 3 banding procedures and just told me to keep on doing the keegel exercise as it’s lose now. I am constantly watching my diet but still when I feel it, it still puts a strain as the bulge will come out first. Right now, I am still feeling it (It has been 4 months already) I run multiple restaurant locations, so I am standing most of the time and activelyon the floor. Is there something that I can do so as not to make it worse as I age?

  4. Hi .. 60:yr old male .. generally fit …, get prolapse when running or lifting .. very painful .. usually have to stop what I’m doing … I’ve just read about your exercises which I’ll start immediately.. would an expanding anal plug (persistent) help during running/excercise ? .. any good ideas to be able to keep running ? Thankyou.

  5. Dear Michelle
    I am 62 years, no history of constipation or bleeding while passing stools. Last two weeks, feel a small bulge coming out while passing stools. Am able to push it back in with my fingers. Can Kegel exercises prevent the condition getting worse? Yet to see a Dr

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Vijir
      I’m not quite sure whether you’re referring to a bulge from the anus or vagina. Mild to moderate prolapse from the vagina may respond to Kegels however with a rectal prolapse (from the anus) this will likely require surgery. It’s best to get any lump/bulge assessed by your doctor.

  6. Hello, I am a 17 year old male and I have mucosal prolapse. I don’t have the money to get an appointment and I don’t think it is that bad. It isn’t that severe as only a bit of tissue has been sticking out which can be pushed back in. Although, it has been hurting when I walk and do exercise. Will diet and exercise solve this? I’m not very convinced. Thank you very much.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Timothee
      Yes I suspect you’re correct – Kegels and avoiding constipation may help however these conditions are likely to progress over time. Try not to let yours progress as when this stays out of the rectum it is a medical emergency. Meanwhile attend to all the things that will potentially help you avoid constipation plus doing Kegels for men too. All the best!

  7. Hello,
    I am 36 and at my second pregnancy (8th month). i have started having some hemorrhoids issues after the birth of my first child, which the doctor did not consider worth intervening on apart from diet and a local cream. They resolved after 5-6 months from giving birth.
    This time I have started having some lumps and discomfort since the 6-7th month already. I am trying to do kegels at least twice a day and I am contacting a doctor again but I was wondering if you could suggest any best practise to avoid that this problem interferes with/worsens after the birth.
    Many thanks

  8. Hi mam! I am a 23 year old female.Around 3 months ago i noticed a bulge at my anus which grew into a lump over time and also a tissue sticking out of my anus.I am currently on medication and feel improvement about the lump but the mass is still sticking out of my anus though it’s very tiny. can doing kegels revert it properly?? If so, how much time can it take to heal completely or the kegels can only help the condition from getting worse?? I m really worried about the severity of the condition.
    Thank you!!

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Surbhi
      I’m sorry i can’t answer this question – it depends on what your diagnosis is. If it is an external hemorrhoid then it may resolve and leave a small tag. Kegels can help bowel emptying issues, it’s important to contract and then completely relax the pelvic floor muscles too. Kegels are definitely important lifelong for maintaining the health of the pelvic floor so I can only see the potential for positive outcomes from doing Kegels for most women. I hope this helps

  9. Hi! Yesterday i found a little lump on my anus. I’m 17 years old and i don’t have that much of regular stool. I think my prolapse is in early stage bc the lump is very small. I’m in a little panic mode since i don’t know how i got it and it suddenly just popped out. Will it go back on its own or i should go see doctor? What do you suggest me to do? Thankyou in advance.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Sarah
      No need to panic at all, most likely this is an external hemorrhoid – yes go to your doctor to get this confirmed. It would be a good idea to train yourself to avoid straining and use the correct bowel movement pattern forever as well as watch this video on foods that keep the stool soft. All the best Sarah. Anything unusual like this that happens to your body always just get it confirmed with your doctor.

  10. is it possible to do an activity such as basketball or running if i am fully recovered from rectal prolapse surgery?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi D this is really up to your surgeon to advise you in your situation however having had rectal prolapse surgery I would suggest avoiding high impact exercises, they won’t help

  11. Hi I was wondering if the exercises could possibly help to where surgery might not be needed

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      It depends on the severity of the prolapse Heather. In the case of a true rectal prolapse where the rectum protrudes from the anus surgery is required however this is often confused with prolapse of the rectum through the back wall of the vagina in which case strengthening may assist to avoid surgery in some cases.

  12. Hi Michelle,
    Thanks for all the information you provide. I’m 56 slim and have been diagnosed with a grade 3 pelvic prolapse and small rectocele which is beginning to feel heavier recently. Since being diagnosed I’ve virtually stopped exercising and now my bum ,tummy and thighs feel flabby ( I know menopause contributes towards that too) but I want to ask if you can recommend some glute, tummy and thigh toning exercises to tighten them up again please? I’m guessing keeping the muscles toned in the glutes etc help the prolapse? Thanks

  13. Roselle cohen says

    Hi. Are there any breast firming exercises you can do that are safe for your pelvic floor?
    Thanks
    Roselle. Stay safe and healthy

  14. Hi. Michelle I have been doing pelvic strengthening exercises is there anything different exercises for bowel prolapse? Thanks. Roselle

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Roselle good question – pelvic floor exercises are generally the same regardless of the type of prolapse. Do focus on the squeeze and inwards lift in and around the anus if the issue is a small rectal prolapse, all the best!

  15. Hello, I had rectal hemmorroids for the first time in January. It was very painful and I had a lump sticking out of my anus. The doctor said that the hemmorroid(s) was internal and pushing down causing a partial prolapse. The pain has all gone, I have blood now and then but not a lot. I can’t really go to the doctor’s at the moment due to the current covid 19 lock down and it’s not an emergency. I want to try these exercises, how long does it normally take to work? And what else should I do to push it back in? I really hate it and want it to be normal again. I’m a 33 year old female. Thanks

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Sara bleeding needs to be assessed by the doctor so an accurate assessment is important. External hemorrhoids can often leave a tag of skin protruding when the acute episode resolves. Pelvic floor exercises usually don’t make a great deal of difference months after the hemorrhoid but they’re important for pelvic health regardless, all the best

  16. I have a enlarge recriminations seal. I really do not want surgery. I been pooping slot. I am overweight. By losing weight will that help it

  17. Lubega Maya says

    Hi , am lubega Maya from Uganda . it’s now two weeks since I started seeing a rectal prop . But it usually comes out wen I go a long call, I have gotten medical advice but nothing has changed. Am 20 years and have only one son of four months. Am worried, am stuck and and am desperate. I don’t know what to do.
    Can I get better without a surgery please??

  18. Hi I am 43, almost 4 months post hysterectomy, everything removed except ovaries. I have had constipation for decades due to taking strong iron supplements for anemia due to heavy cycles and I am currently still on iron due to heavy loss during my surgery. 3 months prior to my Hysterectomy I noticed feeling heaviness/ pressure. I thought that it was my enlarged uterus pushing down, but was informed after surgery I have a mild prolapse of the wall of my bowel. Prior to noticing the pressure, I was running a couple of times per week and doing Zumba 4-5 times a week. I have decided not to run anymore since I have had a hysterectomy and want to protect my pelvic floor, though my gynecologist says it’s strong, I have been told to never lift heavier than 15kg. I have just started back at Zumba as I was told I could 3 months after surgery. I’m not jumping, keeping it low impact and wondered if this is still a safe exercise for me to be doing?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Linda
      I would think that low impact Zumba should be a nice exercise for you if you’ve had your pelvic floor assessed as strong and working well. Remember that there are many different forms of Zumba and some can impact more upon the pelvic floor than others. This information on Zumba and prolapse From your history, the big thing for you to manage for your pelvic floor protection would also be your constipation as this poses a real risk to your pelvic floor, especially with your iron supplementation. I hope this helps

    • Ronnie Link says

      Hi Linda. I have a rectal prolapse and wondering if you had surgery on it.

      • i have rectal prolapse problem at age 5 year .now i am 25 year.i didn’t feel any problem while blowing but now in 2 to 3 month my stomach not completely empty .some very small hole to pass blow ,i can’t do surgery please suggest any other options to get recover

  19. Would love to see your video!

  20. I am 90 , Care for 6 Horses and ride daily; but have had 4 children and several miscarriages; non the less felt in great health until the shock of rectal prolapse. At my age am determined to avoid surgery and have been doing Kegel and other exercises ; I think I see some improvement – am I being unrealistic ? I am a vegetarian and weigh 110 pound at 5 ft 2””

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Alice
      Yes muscles can strengthen at any age and that is what you’re experiencing. Keep up your exercises, if you’ve only just started you can expect to notice more improvement. Keep up your great work!

      • Hi… im having ibs C for 2 years. This makes my rectus prolapse partially.. i found coffe enema is helping me more.. can i use enema in case of prolapse?

        • Author: Michelle Kenway Pelvic Floor Physiotherapist says

          Coffee enema should not be an issue for prolapse unless it irritates the bowel and causes you to have forceful diarrhea, otherwise enema has no physical impact on prolapse

  21. very well explained

  22. I was wondering if a tens machine would help.I am 73 and finding it difficult to find the right muscles to excercise.An operation is out of the question unless it is really needed due to my Chrohns.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Maureen
      Electronic stimulation can help some women learn to activate their pelvic floor muscles. This should be done under the supervision of a Pelvic Floor Physio.

  23. DO the exercises always work even if the prolapse is seen outside of the rectum?

    • Michelle Kenway Physiotherapist says

      Barbara this depends on whether the prolapse is just the rectal mucosal tissue or more extensive. Either way the pelvic floor exercises are a vital part of the long-term management even if surgery is required.

  24. hii. I want to know if it is normal that some part of anus is out while pushing? i noticed some problem when i once stretched my leg apart for some reason. I m 25 male.

  25. Hi Michelle
    You helped me before so back for your excellent advice
    Had ant/post repair and hysterectomy couple of years ago plus oophrectomy for ca breast 12yrs ago
    Son born severe shoulder dystocia needed extensive episiotomy to get him out,

    Back and pelvic discomfort worsened since xmas then last week severe back and rectal pain sudden constipation and inability to evacuate bowel (never a problem before) possible intususseption
    Should I look at surgery route pelvic floor strong as it can but problem seems all rectal.Laid in bed for 3 days symptoms improved but once back up started again. Only 52 with young family so cant sit around all day.
    Thanks
    Vanessa

    • Michelle Kenway Physiotherapist says

      Hi Vanessa

      Thanks for your question about rectal intussusception or infolding of the rectal walls for the benefit of other readers. First I would suggest you have a complete assessment with a colorectal surgeon and undergo the recommended investigations so that you know exactly what you’re dealing with, especially the extent of the intussusception. This is usually a surgical fix Vanessa – diet, correct defaecation position and technique and pelvic floor exercises are important too for long term management however unlikely to resolve the situation for you. Let me know how you go – always interested to hear the outcomes.

      All the best
      Michelle

  26. My 80+ mother-in-law has a prolapsed rectum she had surgery for about six months ago. We’ve just found out it has been dropping out again for about 3 months and she refuses to call her doctor until after the holidays (2 weeks). We asked if she has been continuing her increased water and a fiber supplement, and she says no. Everything I read indicates that soft formed stools without straining are helpful to avoid prolapse complications, but she is absolutely convinced that fiber will make her diarrhea (probably IBS–she is a bundle of anxiety) worse. Is it possible that she’s right about that? I don’t want to insist on something that will make her worse, but I suspect her doctor has tunnel vision for surgery and is either ignorant about self care measures like exercises and diet or just doesn’t think she’ll bother. Any ideas?

  27. Gday. Ive had ulcerative colitis for 5 years and have pretty much beaten it. The problem now is after 5 years of straining i have a pretty bad prolapse. Im a 25 year old male but found this info really helpfull, there isnt a lot out there for us. Im laying in bed in agony after emptying my bowels and am doing your exercises and its actually helping the pain. The doctors dont want to operate incase the colitis comes back so ive got to do it the natural way. The problem is they didnt really tell me how to, only to go and see a physio. I have a realy hard time emptying my bowels and am always straining, even if i try not to. After watching your video i will try those techniques next time and hopefully start getting some ware. I realised that i have a terrible posture when on the toilet now haha. Thanks so much for the info!!

    John

    • Michelle Kenway Physiotherapist says

      Hi John
      Thanks so much for sharing your experience for the benefit of other readers who will no doubt identify with your experience. I hope you can see a pelvic floor physio to help you. If you’re able to access treatment with an accredited practicing dietician if you haven’t already done so this will be of benefit to you too. This may help you get the right stool consistency to help you reduce your need to strain along with the bowel emptying technique that I have on site.
      All the best to you John
      Michelle

  28. Hi! I was just diagnosed with moderate insufficient pelvic floor dysfunction, posterior/anterior rectocele, and rectal intussusception. Yay! BOO! They didn’t tell me how bad it was (apparently it wasn’t indicated on the report – ugh). But bad enough to refer to me physical therapy and give the name of a surgeon (I’m hoping the surgeon referral is just protocol). Naturally, I’m freaking out and want to work on strengthening the muscles using the exercises you listed above. A couple of questions: 1. when I tighten the muscles am I supposed to leave my anus relaxed?; 2. Can you describe this a little better: “Next practice lifting and squeezing your pelvic floor muscles with a brisk strong technique for up to 10 times”. Is it like a breath-of-fire technique?

    Thank you for the proper way to go to the toilet!! I’ve been straining my ENTIRE life (I’m 45). I tried it this am and completely failed. I know I’ll have to practice. It’s just hard to relax and use the proper muscles AND splint at the same time.

    I live in the states and want to purchase your book. Do you ship here? I’ve only gotten as far as the product page and see that it’s in foreign currency.

  29. Hi Michelle, could you please let me know, What are your qualifications in rectal prolapse treatment/where does your research and knowledge stem from? Some of your advisory information is directly opposing to pelvic floor colorectal consultants I have seen in my history with rectal prolapse, I do not mean to appear rude but there is so much conflicting information around it is so so hard to know who to listen to, and what is the correct way to deal with/manage this treatment. There is also conflicting information given to me by continence nurses, and pelvic floor nurse to the doctors. It is a minefield of confusion. I am just in my 20’s and very scared how to avoid this worsening, though it seems inevitable, as I have tried most advisories already, including surgery and all has not helped this far.

  30. Hi Michelle I don’t know if you’ll reply to this message but I’d really appreciate some advice seeing that you are so knowledgeable on the issue. I’m 19 and 2 days ago I was diagnosed with mucosal rectal relapse. At this point I know it’s not curable but I really want to avoid getting surgery as best as I can. My symptoms aren’t severe and the protrusion isn’t that large. It protrudes when I have to use the bathroom. Honestly I can live with it just protruding when I need to use the bath while straining but I”m so afraid of it becoming worse. I’ve recently begun eating more fibre to soften my stools and I have stopped straining when going to the bathroom. I’ve begun doing kegel exercises as well. What I really want to know is, will it ever get so bad that the protrusion occurs spontaneously? Even when just walking or standing up? Regardless if I take these preemptive measures now? I also weight train. Can you perhaps suggest resistance exercises that don’t strain the pelvic floor? So many questions I know but at this point I feel like I’m gonna have further problems down the line considering that I’m so young.

  31. Bayla Singer says

    Hi Michelle,
    I am a 45 year old woman who has had 5 natural childbirths. My vagina prolapsed after the first baby, after the 5th, my Gynecologist said I also had rectal prolapse as well. I used a pessary and did kegel exercises with the aid of a little electronic stimulator that you use intravaginally. Ok, so all my symptoms got much better unless I had to walk a long distance or was all day on my feet, then my bottom literally felt like it was dragging on the floor! And if that isn’t bad enough, I am experiencing worsening of my rectal prolapse. I have times of the day where my stool just leaks out without warning. I hate this, its so disgusting. I wish to avoid any surgery, so can I find a way to get this situation back under control? Will using a pessary help my rectal prolapse?
    Thanks so much,
    Bayla

  32. This is a very much important & helpful suggestion & advise..Thanks a lot..I am using all these suggestion to manage myself..
    My self PT. Hetal Mehta..
    I have rectal prolapse & internal hemmroids…I
    want to know adhesion of rectal prolapse is possible or not??

  33. Hi Michelle, I’m in the UK and was looking around the Internet for some info on rectal prolapse to help my 32 year old daughter. She has disabilities, including dyspraxia, joint hyper laxity, weak muscles and a moderate learning disability.

    For the past year she has been spending more and more time in the bathroom. I hear the loo flush then she runs the bath, alternating between the two. She has complained of stomach pain and her tummy looks bloated. She now spends several hours a day in the bathroom. This week I took her to the doctor after she called me into the bathroom for help to clean up and I saw the rectal prolapse which thankfully retracted. The doctor is seeking the advice of a PT about pelvic floor excercises to try and avoid surgery.

    I am really worried as my daughter is about to begin living independently with domiciliary support and I fear this will become a big problem for her as it seems to be happening frequently. Sometimes she says she needs a pee but can’t do it. I am wondering if all this is due to some kind of sensory problem.

    For the last two years she has been prescribed Sertriline for anxiety and more recently Olanzapine for psychosis. The latter has caused her to gain some weight.

    Any advice you can give will be greatly received. I am unable to play the online video on how to empty the bowel properly.

    Lynne

    • Michelle Kenway says

      Hi Lynne

      Thanks for your question – it sounds as though a multifaceted approach is needed here. First and foremost has your daughter’s doctor considered a colonoscopy to investigate the stomach bloating? There are many potential causes of abdo bloating. Bloating will increase pressure on her pelvic floor and prolapse. The cause needs to be established and then appropriate intervention used whether it be dietary management (which is a possibility).

      Education in good bowel habits is vital, especially if your daughter is going to be living independently. She needs to know and practice:
      * how to empty her bowel using the correct position and technique (here’s the you tube video
      bowel emptying video link
      * the importance of avoiding prolonged sitting on the toilet to empty – this is vital!
      * the importance of never straining to empty – again vital
      * recognising an appropriate urge to empty
      * choosing bowel friendly foods that keep the stool soft, well formed and readily passed
      * personal hygiene/ how to clean well with a rectal prolapse (an be challenging)
      * barrier protection if there is any bowel leakage or incomplete cleaning to prevent tissue breakdown around the anus

      Pelvic floor physiotherapy can train pelvic floor muscle support, sensory awareness regarding rectal filling as well as bowel emptying position and technique. Dietary management may be warranted via an accredited practicing dietician who works with bowel issues.

      So I hope this gives you some direction in managing this challenging issue Lynne

      All the best and stay in touch
      Michelle

  34. Hi Michelle. I am 55. 37 years of constipation after traumatic childbirth trauma and recently finding out I have intussusception ( telescoping of the bowel) due to that delivery. Constipation managed well as into health foods up until last February had vaginal prolapse surgery that theoretically the gynaecologist said the surgery would set the bowel free. Well since that surgery my bowel does not work at all without an array of herbs and bowel tonics and at least two enemas a day. I consume mostly juices and smoothies now. Am now further diagnosed with rectocele, defection obstruction and tests last week confirmed very little nerve function in the bowel. Bowel surgeon said surgery would further damage me and fixing the intussusception would only be temporary as would intussusception again. I am due next month for a urology test and then a professor in gynaecology who knows the bowel surgeon will not operate. Hopefully answers after appointment but at least now surviving after being in intensive care for two weeks last year. Would love to eat and put on weight. I have found kegel exercises very straining and just started an hour ago doing your exercises and feeling hopeful. Thanks so much. If there is anything else you would suggest would love to hear from you.
    Thanks
    Tracey

    • Michelle Kenway says

      Hi Tracey

      Thanks so much for sharing your history and for your question. Tracey which exercises have you started, i have so many online I just want to see where you have started and point you to safe options to help you out.

      What are your main exercise goals Tracey? I can see your desire to put on weight – are you seeking to do this with some resistance training? I think there are options within your capacity.

      Have you seen a dietician? It strikes me that you would benefit greatly from some professional guidance in this regard too, I am immediately thinking along the lines of high energy readily digestible protein powders and other digestible protein such as eggs however your presentation is complex and your dietary requirements are beyond my realm of expertise and I would definitely be inclined to source a dietician to assist you too.

      As for exercise I can assist you further, let me know where you’ve started and I can go from there.

      Best wishes to you Tracey
      Michelle

  35. Hello :)
    Glad to see your site :) I’ve had rectal prolapse for about 16 years starting in my early 20’s. I have IBS so straining to go was/is common. Sometimes I’m completely normal and there is no sign of it but most times it’s present and still other times(usually brought on by anything triggering my immune system ie food allergies & sesitivities, illness, arthritis flare ups)… It comes on like contractions and until every last bit of anything inside is out the contractions/straining won’t stop and the prolapse will just keep popping out.

    I’ve had plenty of embarrassing episodes throughout the years. Have learned to take extra underwear with me everywhere. Usually place tp or a makeup pad as a sort of minor plug. When out and about I take wet wipes with ( the ones in individual packets scented for vaginal wipes are really handy to take everywhere & smell nice). Staying fit is important – it is hard to control muscles that you can’t identify or feel but they are very possible to control if you are fit and def identify and foods that may trigger lack of control & eliminate them – you don’t need them trust me. This may sound odd but when home it is common for me to use the bathtub faucet to completely clean off the prolapse (after going to the bathroom in the toilet of course) before “sucking it back it” (which absolutely takes plenty of muscle control) just warm/hot water on the prolapse, no soap or irritants. I would love to put in a bidet.

    I fear that I can not have the surgery bc the IBS and involuntary straining would just pop the stitches and make it even worse. I also need to avoid most medications bc of auto immune disorders as dancing with the side effects I know are better than those I don’t (uncomfortable/embarrassing vs illness or death).

    I have cobbled together a way to live with this embarrassing, inconvenient, and uncomfortable situation but I so wish I didn’t have to. I very much fear getting older and it getting worse or being too old or weak to control it anymore. My husband of 10 years only kind of knows about this but I’ve only delivered a glossed over version of the problem without spelling out what really happens or all that I have to deal with and the insane about of time I have to spend in the bathroom. I would far rather leave it a mystery to him rather than have that in his mind = not sexy. Gone are the days of wearing thongs to avoid panty lines!

    In the end I keep myself meticulously clean and smelling like daisies, my rectum is probably way cleaner that other humans and my bathroom is gloriously spotless since I clean it so often! I’m prompted to share my story in hopes that it connects with others dealing with this and It’s really nice to know that I’m not alone :)

    • Michelle Kenway says

      Hi Reb
      Thank you so much for taking the time to share your story! Yes Reb you are not alone!

      Your story will no doubt help many other women, too often stories like yours are hidden away so that many women feel that they are going solo on these issues when in reality they are not.

      Reb can I ask you have you heard of FODMAPS? I am not sure where you are worldwide and I am sure you have tried everything to manage your IBS. There is a considerable body of research supporting FODMAPS for IBS let me know if you would like me to post a link. I think it is worthy of a post for women like yourself – I will pop on my to do list.

      Thanks so much
      Michelle

    • I’m 47 and just rectal prolapse surgery this past December! I was so tired of dealing with it and told that it would get worse! It was so embarrassing working out at the gym and my anus would pop out! So far I’m healing fine and looking forward to working out again in a few months!

      • Author: Michelle Kenway Pelvic Floor Physiotherapist says

        So great to read this Alisa! Take care and all the best for your long-term recovery. Thanks so much for commenting to help others

  36. Hi, I have had prolapse for many years and have never got proper treatment for it. It was initially misdiagnosed as haemorrhoids. I live in a very poor country and doubt there is any doctor who can handle a surgery so I’ve put it off for fear of messing me up. Any advice? 7 years to be precise

    • Michelle Kenway says

      Hi Eve

      Thank you for contacting me for information – I am happy to assist you if I can.

      So that I can reply appropriately do you know what type of prolapse it is? Is it a vaginal or rectal prolapse (ie protruding from the rectum)?

      Regards
      Michelle

  37. Hello,
    I have been diagnosed with a mucosal rectal prolapse. I have been referred to a pelvic floor physio and will be starting biofeedback. I also bought your book and DVD on pelvic floor exercises. With the exercises and biofeedback is it possible to improve my condition or am I merely preventing it from getting worse? I’m only 33 and my symptoms distress me greatly :-(. Can your exercises also help if the issue is weak anal sphincter? I don’t know if I have this but it is possible. Also I read your link in how to have a BM but i wonder what do you do when you need to have a BM away from home. Thank you

    • Michelle Kenway says

      Hi Lisa

      My apologies for the delay, your question somehow skipped past me until now.

      Yes this is so distressing for you, this must be difficult to deal with indeed.

      I think the degree of improvement you can expect will depend upon how well your pelvic floor muscles are currently functioning and whether there are other factors that can be modified to assist with your overall management. If your pelvic floor muscles are weak then strengthening may help to improve your condition. Similarly if your stool consistency is problematic then improving your stool consistency will help, if overweight then weight loss may benefit your condition so you can see there are many potential factors influencing your current condition. Your physio will be likely to address these factors as part of your overall management.

      Bowel movements away from home are ideally managed the same as at home, was there something specific that you wanted to ask about with regards to a particular issue you are having? I am most happy to assist you if I can.

      Thank you for your questions Lisa
      Michelle

  38. Patricia Bryant says

    I have had a vaginal prolapse I surgery and they used the mesh. Then a mesh erosion and that had to be repaired. Long story short I was left with a bladder that will not empty and I cath twice a day. I do have a bowel prolapse now. I have been to several urologist I feel like I have just been pushed aside. Now the one urologist said if I do the pelvic floor exercise for the bowel that it could make the muscles for the bladder worse and I could have to wear a cath full time. So this said do I take the chance?

    • Michelle Kenway says

      Hi Patricia
      I wonder why the Urologist said this – did you manage to ask why the pelvic floor exercises could worsen your condition? I know it’s difficult in a consultation to think of these things, I am just interested in the rationale behind this view. Patricia I am not sure where you are writing from but do you have access to a pelvic floor physiotherapist or continence nurse advisor to help you with your bladder emptying technique?

      You may find this online video on how to empty the bladder helpful too Patricia

      I will be interested to hear back from you if you are able to reply.

      Michelle

  39. Hi, Thanks for the video.
    I am a 21 years old male. I have mucosal rectal prolapse for around two years. I had regular constipation due to bad food habit and used to strain a lot. Can you please tell me if prolapse reversible or I have to live my whole life with this?

    • Michelle Kenway says

      Hi Biwas

      Once you have a rectal prolapse it is there for good – this is becuase the tissues have stretched beyond their limits. If you imagine stretching elastic beyond its limits it’s the same principle – it won’t return to its former length or form.

      Depending on the severity of the mucosal prolapse you can potentially improve the condition with a good program of pelvic floor exercises along with very good bowel management (avoiding straining, using the correct bowel emptying technique, appropriate diet for correct stool consistency). Lifestyle factors including avoiding heavy lifting and appropriate exercise are also factors to be aware of to prevent rectal prolapse worsening.

      This Pelvic Floor Exercises DVD for Men is an excellent and inexepensive resource for men who are unable to access formal physiotherapy treatment to help strengthen their pelvic floor muscles.

      I hope this information helps you out Biwas

      Regards
      Michelle

  40. How can I get this book please to in prove my bowels and excersize thanks

  41. I would love the book ive adds surgery for prolapse on my bowel

  42. Hi Michelle, Thank you for you info….have been in contact with the centre and they cannot take me before april….so will have to wait..have view a few of your videos and will try and do the suggested exercises…will let you know how i get on…i was so relieved to find your page as it has given me so much information and answered so many of my questions.
    Again thanks,
    Angela.

    • Michelle Kenway says

      Hi Angela
      All the best to you – please let me know if there is any other information I can help you with while you wait, and yes keen to hear how things go for you.
      Michelle

  43. Iam a 51yrs women who had a total bowel obstruction 12 months ago had surgery which discovered i had malrotation of the bowel and had bands and adhesions which were causing the bowel obstruction, recovered well and bowel movements went back to normal for about 3 months then bowel stopped again the surgeon thought i had another obstruction had more surgery and not obstruction had been found. since then the only way i empty is by taking picalax medication every second day have had ..ct..mri..and barium orally and rectum which has discovered that i ave intussusception of the lower bowel just before the rectum so when i feel the need to go i sit an nothing happens….only with the picalax do i get movement this is since last may…. am only being referred to a pelvic floor center but have to wait till May for my appointment….my symptoms are not being able to empty or pass wind and everytime i have a meal no matter how small i get severe abdominal distention and colic like pain which will build all day and by evening i am completely debilitated , if i go walking i get abdominal pain … the position of sitting in the car causes abdominal distention and pain…can no longer ly on by sides in bed as it causes awful pain..will wake everynight …also take trmadol for pain…diet and fluid has all been tried with no results. my question is how is pelvic exercises going to cure me…have been doing my own pelvic exercises myself since being told about intussusception in december but am not getting any improvement am at wits end here….

    • Michelle Kenway says

      Hi Angela

      Thanks so much for your comment and for sharing your experience here, yes I can see why you must feel at your wits end. Pelvic floor physiotherapy can help bowel management in a number of ways – teach correct bowel emptying position and technique (after assessment of your current emptying problems), assess and modify stool consistency with appropriate diet, and of course teach how to strengthen and relax your pelvic floor muscles according individual assessment. Your physiotherapist will assess you and then based upon this assessment implement appropriate treatment.

      Angela I would also recommend that you read some of this information which may also assist you – trying to reduce gas with diet and management, achieve a good stool consistency and overcome constipation and empty your bowels using the technique to avoid straining.

      Angela have you considered asking your doctor to phone the centre on your behalf to assist you towards an earlier appointment or perhaps contact the centre yourself and ask to list your name on a cancellation list if they have one?

      Please don’t hesitate to contact me further if I can assist you
      Kindest regards
      Michelle

  44. hello
    just on this site for the first time. Iam not sure of the problem i have but since 4 years i have been dealing with the problem of constipation with a lot of straining when having a bowel moving. and since then i have used a lot of stool softeners including enemas. so at the stage aim now even the soft stool takes long to come out. i have seen doctors i did a T-scan they still find nothing wrong with but within myself i know that i have a big problem. Please i need your help to have my normal life back. thanks

    • Michelle Kenway says

      Hi Lizy
      Unfortunately I am unable to diagnose your problem however I can suggest that you watch this bowel movement video which may help you with your emptying technique. The critical thing is to bulge the abdomen forwards as this relaxes the external anal sphincter during the bowel movement. When women strain to empty their bowels they usually draw the abdomen in strongly which contracts the anal sphincter and actually makes the problem worse. You may also like to read this article on pelvic floor muscle tension, it may/may not apply to you.
      Hope this gives you some direction
      Michelle

  45. Thanks for your response, Michelle. Can a pessary be used in the rectum? I thought that was more appropriate for a vaginal prolapse?

    • Michelle Kenway says

      Hi Bella

      Yes pessaries are for vaginal prolapse, you are correct. Support pessaries are not used in the rectum. The conservative management of rectal prolapse is usually primarily focused on bowel management (good bowel emptying technique, stool consistency) and pelvic floor strengthening. When this fails, or if the rectal prolapse is severe then surgery is used for management.

      Best of luck
      Michelle

  46. I have a full rectal prolapse. It is not due to constipation (I’m vegan). But is due to straining to fully empty my bladder. What exercises can I do to reduce this. Going to the bathroom now requires that I push my rectum back most of the time. Sometimes if I half stand up it will recoil back inside me.

    I’m new to this site and am interested in videos as well as books and advice.

    Thank you so much! I hate this!

    • Michelle Kenway says

      Hi Lori
      Yes agreed rectal prolapse is a challenging condition to manage. I think it is worth mentioning that with a vegetarian diet there still can be challenges for the bowel since the high insoluble fibre content can make the stool bulky and a little difficult to pass at times, stool consistency is a key area to manage with this condition ensuring that it is well formed and soft to pass. If the prolapse does not return into the rectum upon standing this is a medical emergency and I think this is important to mention if this occurs.
      Best of luck with your management
      Michelle

  47. Hi Michelle!
    I’m a 26 year old female struggling with issues relating to a rectal prolapse. Before these issues, I was very active. I’m an avid gym goer, but I feel there is not much I can do anymore.
    I miss Step classes and boxing the most- is there any way I can get back into either of those forms of exercise without damaging myself more? :(
    I’ve been seeing a pelvic floor physiotherapist for a while now and I know which exercises are recommended, but the low impact and light weights are driving me crazy and I’m no longer getting any joy out of keeping active.
    If you have any advice, it would be greatly appreciated.
    Thanks!
    Bella

    • Michelle Kenway says

      Hi Bella

      Yes I understand your frustration. Have you considered using a pessary to help you with your activity? This article on support pessary will give you a little more info – you would need to be assessed and fitted by your gynaecologist, some Australian Pelvic Floor Physios are also now fitting pessaries.

      Hope this gives you some help with this issue
      Michelle

  48. Hi Michelle,
    I look forward to your monthly newsletter. It is good to reaffirm the pelvic floor exercises; especially how to modify those exercises in aerobic and pilates classes to make them safe for me I found that to be of enormous benefit, and I won’t feel self conscious now when I am doing something different to the others. Could you give me an alternative to doing squats when in a circle at the beginning of our aerobic class.
    Thank you,
    Kathy

    • Michelle Kenway says

      Hi Kathy
      Why not do minisquats? Feet about hip width apart, butt goes back as trunk inclines slightly forward, a nice alternative to traditional wide deep squats. Let me know if you need further description on how to do this exercise. This can be combined with arm reach forward too. It’s a lovely exercise and you will feel like you are doing something similar to the others, and therefore less conspicuous.
      Cheers
      Michelle

  49. Will these exercises help reverse the prolapse, or just keep it from getting worse?

  50. Marilyn Burns says

    Hi Michelle:
    I’m so glad to be on your mailing list. The information you are giving us is critical to our well being. I have your book on my night stand for those awake minutes during the night.

    I’m glad to see the expanded subjects — I surely hope all the women in this world find your website

    Sincerely,
    Marilyn

    • Michelle Kenway says

      Hi Marilyn
      How lovely to hear from you! I hope you are well. It’s been a while, my sincere apologies I have been flat out with my family and working (just like so many other women). I hope the changes help you find information more readily. I plan to be in touch with you on a monthly basis now that I am close to catching up so let me know if there’s anything you need.
      Best wishes to you Marilyn
      Michelle

  51. I just found your site and have been trying to use your video on how to
    > have
    > a BM without straining the pelvic floor.
    >
    > I had a hysterectomy 7 weeks ago and have been recovering well except that
    > last week I had a pretty bad rectum prolapse. I have delt with chronic
    > Constipation for the last few years and off and on before that. I was
    > having
    > a bad bout with it and strained too much and enough came out that I had to
    > go to E. R. at the hospital. They got it back in. Now I am taking lots of
    > stool softeners and trying to be very careful how I go. So far am doing
    > not
    > too bad thanks to finding your video. No doctors or nurses that I talked
    > to
    > were any help at all.
    >
    > Have an appt. next Friday with a P.T. who specializes in pelvic floor. So
    > am
    > hoping she can tell me if I can work this out with P.T. or will I need
    > more
    > surgery. I am a strong healthy 56 year old with a tricky digestive system.
    >
    > I know you can`t give advice but if you could steer me to any of your
    > articles about rectum prolapse I would appreciate it. I think it was
    > brought
    > on by years of straining and the hysterectomy. I have never had children.
    > I
    > am wondering if my obgyn should not have made more sure that I did not
    > have
    > any of these problems already that might have needed repair before going
    > into surgery. (I had a abdominal with a 4 pound fibroid.) Now she seems to
    > not want to be bothered with me anymore. I just didn`t know much about all
    > this before the surgery. Didn`t know what to ask even. Now am wondering if
    > they couldn`t have done some repair work at the same time.
    >
    > Glad I found your video anyway. It saved me when I had no idea how I was
    > going to have a BM without the rectum prolapse again. (It was very
    > painful)And stool softeners have helped a lot too. Mirilax and ducosate.
    >
    > Thanks,
    >
    > Rachel
    >

    • Hi Rachel
      Thanks for your great comments. Yes we completely agree with you – it is possible that in many cases rectal prolapse can be prevented particularly by educating women like yourself who deal with chronic constipation and who therefore at increased risk of prolapse. Rectal prolapse is often the unforseen painful outcome of years of straining with constipation. If women understand; the risks associated with chronic straining to empty their bowels, how to empty their bowels correctly and relax their pelvic floor muscles, in addition to understanding how to keep their stool a good consistency through diet, exercise and appropriate medications if required then the incidence of rectal prolapse would be vastly decreased without a doubt. Following gynae surgery for prolapse repair and perhaps hysterectomy the risk of prolapse may be further increased, particularly in the early days when constipation may recur. The big thing to manage this long term aside from those factors already mentioned is getting the pelvic floor muscles functioning really well to support the rectum and anus, and prevent repeat rectal prolapse.

      Rachel you will find numerous article and videos on how to strengthen with pelvic floor exercises and for prolapse exercises. A great starting point is the free complimentary pelvic floor or kegel exercise video which you can access on our home page by entering your email address. Also watch this video on how to avoiding repeat prolapse.

      Hope this information helps you Rachel, best of luck with your recovery and health. Please let us know how you go, Michelle