What raises the risk of rectal prolapse
Executive summary
Rectal prolapse most commonly affects elderly, multiparous women and is linked to pelvic floor weakness and chronic straining from constipation; sources list chronic constipation, pelvic floor dysfunction, prior pelvic surgery, multiparity/vaginal delivery, and connective‑tissue disorders among the leading risk factors [1] [2] [3]. Additional, more specific risk contributors reported in subsets include psychiatric‑medication–induced constipation in younger patients, redundant sigmoid or inflammatory bowel disease, and anatomic or sacral abnormalities after anorectal malformation repair [4] [5] [6].
1. Who gets rectal prolapse — the big picture
Rectal prolapse clusters at the extremes of age: most frequently in elderly, multiparous women and also in children, with different drivers in each group; geriatric cases are tied to tissue and pelvic‑floor weakening while pediatric cases often relate to diarrheal illness or cystic fibrosis in some reports [1] [2] [7].
2. Constipation and chronic straining: the central mechanical driver
Multiple reviews and clinical summaries identify increased intra‑abdominal pressure from excessive straining — typically due to chronic constipation — as a primary, modifiable risk factor. Authors and guidelines stress that optimizing bowel habits is crucial because straining repeatedly exposes pelvic supports to forces that can lead to rectal intussusception and eventual full‑thickness prolapse [2] [3].
3. Pelvic floor weakness, childbirth and prior pelvic surgery
Weak pelvic floor muscles from aging, multiple vaginal deliveries, prolonged labor or prior pelvic surgery reduce support for the rectum and are repeatedly named as risk factors; several sources also point to previous pelvic operations as a contributor in younger patients, implying iatrogenic weakening can matter [3] [4].
4. Connective‑tissue and systemic contributors (genetics, obesity, neuro conditions)
Connective‑tissue disorders (for example, Ehlers‑Danlos in some series), obesity, and neurologic conditions that affect pelvic‑floor function (dementia, stroke) are described as increasing risk because they impair tissue integrity or neuromuscular control, widening the range of non‑mechanical contributors to prolapse [1] [3].
5. Special populations: young adults, children and post‑ARM repair patients
Young adults with rectal prolapse are uncommon but studies highlight distinct associations: psychiatric patients whose medications cause constipation, redundant sigmoid colon, inflammatory bowel disease, irritable bowel syndrome, and family history of GI disease appear in case series [4] [5]. After surgical repair of anorectal malformations (ARM) in children, male sex, complex ARM types and sacral/vertebral anomalies predict higher post‑operative prolapse risk [6] [8].
6. Surgical history and recurrence: technique matters
Surgical approach influences recurrence risk: abstracts and cohort analyses indicate that perineal repairs for recurrent prolapse are associated with higher re‑recurrence compared with abdominal approaches, making operative selection a clinically important risk modifier for future prolapse [9]. Large administrative analyses of complications after prolapse surgery also highlight that patient factors — older age, dependent functional status, longer operations — associate with postoperative venous thromboembolism, though that concerns surgical risk rather than primary prolapse causation [10].
7. Conflicting or limited evidence and where uncertainty remains
Not all sources quantify the strength of each risk factor; systematic reviews and meta‑analyses note heterogeneity across studies and variable definitions of prolapse, making direct comparisons difficult [3]. Available sources do not mention the precise population‑level attributable risk for each factor, so absolute contribution of, say, obesity versus parity is not provided (not found in current reporting).
8. Practical implications: prevention and clinical takeaways
Clinical guidance converges on treatable targets: prevent and treat constipation, counsel about pelvic‑floor rehabilitation, and consider the patient’s anatomy and prior surgeries when deciding management and surgical approach [2] [3] [9]. For children and young adults, clinicians should screen for reversible contributors (medication‑induced constipation, inflammatory bowel disease) identified in case series [4] [5].
Limitations: this summary synthesizes recent clinical studies, reviews and specialty reports that vary in design and population; where sources disagree or lack population‑level quantification, I note that explicitly [3] [9].