Rectal conditions may not be everyday conversation topics, but they’re more common than many people realize — especially for women and those over 50. Too often, symptoms are mistaken for hemorrhoids or simply brushed aside. In reality, there are a couple of different ways the rectum can bulge or shift, and understanding the difference is important for getting the right care. When I heard this audio trending on TikTok, I was inspired to use it to make an explainer video. But I also wanted to share more details about these conditions with KCM readers.
Rectal prolapse occurs when the rectum protrudes through the anus. (This doesn’t always mean it “falls out” completely — sometimes it starts gradually.) These cases are typically managed by colorectal surgeons.
Rectocele, on the other hand, happens when the rectum bulges into the vagina. This condition is more often managed by gynecologists or urogynecologists.
Risk factors for both include age (over 50), being female, chronic constipation or straining, and childbirth. With rectocele, connective tissue disorders such as Ehlers-Danlos, persistent heavy lifting, or chronic coughing can also contribute, though usually on an already weakened pelvic floor or fascia.
How common are they? Rectocele is much more common — many women, particularly those who have been pregnant or given birth, will experience some degree of it. Rectal prolapse, by contrast, is relatively rare.
Symptoms can overlap. Rectal prolapse may cause swelling or discomfort around the anus and bleeding with wiping, which can mimic hemorrhoids. Rectocele may present as a bulge in the vagina, pain with sex, or difficulty emptying the bowels.
The bottom line: If you’re experiencing any of these symptoms, it’s important to see your doctor for an exam. That way, you can identify what’s really happening and get the right treatment.
