What it is
- Internal rectal prolapse (intussusception) can be intra-rectal or intra-anal. It is a structural finding on defecography, not a personality trait.
- In a pelvis with a deep pouch of Douglas and a yielding rectovaginal septum, the telescoping rectum can become an anterior battering ram. That is the mechanical story behind “it telescopes into my uterus and my cervix drops.” It is under-described in clinic and very real on imaging.
- It often travels with rectocele, enterocele or sigmoidocele, perineal descent, and a dyssynergic pelvic floor. Fixing one line on a report rarely fixes the emptying.
- NICE and colorectal societies typically start with conservative care for internal prolapse: bowel regimen, defecatory retraining / biofeedback. Surgery (ventral rectopexy, Delorme, and related repairs) is for refractory, bothersome disease — chosen with someone who does a lot of them.
What it can feel like
- Incomplete emptying, the “I just went and I need to go again” loop
- Tenesmus, mucus, or a plugging sensation
- Pressure low in the pelvis or a bulge that comes and goes with straining
- Splinting, digital assistance, or unusual postures to evacuate
- A cervix that feels lower after a bowel movement or a long day on your feet
What you were probably told
- “If it doesn’t come out of the anus, it isn’t a prolapse.”
- “That’s hemorrhoids. Use cream.”
- “You have IBS. Take fiber and a mood medication.”
- “Your colonoscopy was normal, so the bowel is fine.”
How it actually gets named
- Symptom pattern of obstructed defecation, incontinence, or mixed, plus exam.
- Defecating proctogram or MR defecography is the money test. Ask for a report that names intussusception grade, enterocele/sigmoidocele, rectocele, and perineal descent.
- Anorectal manometry and balloon expulsion help sort dyssynergia from pure structure — many people have both.
- Do not accept “normal colonoscopy” as a pelvic-floor workup.
What tends to help
- A bowel program you can live with: osmotic laxative, fiber that does not bloat you, toilet stool, no straining contests.
- Pelvic floor PT / biofeedback for dyssynergia. If the muscle will not relax, surgery on the telescope may still leave you emptying badly.
- Treat the sigmoidocele and apical support in the same conversation. The telescope and the dropped colon are housemates.
- Surgical options for internal prolapse, when indicated, often center on ventral mesh rectopexy. Mesh conversations should be specific, not internet folklore and not sales pitches.
- If the cervix is descending under this pressure, urogynecology belongs in the room before anyone operates on a single organ.
Take these into the room
- Was intussusception actually seen on defecography, and did it reach toward the vagina or stay intra-rectal?
- Is my emptying problem structure, muscle dyssynergia, or both?
- If this is pressing on my uterus and cervix, who is jointly planning the repair?
- What is the conservative trial you want, and what would make you recommend surgery?