Skip to main contentLast updated: 04-Nov-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
GI & Proctology Surgeon
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad · 18 years of experience
In short
The check has one job: to turn the words “something comes down” or “I cannot empty” into a clear plan. Your story and an examination do most of the work.
Defecography, a moving X-ray or MRI taken while you strain, shows hidden prolapse and how the pelvic floor behaves. It is used when the story or examination leaves a question.
A scope of the bowel is part of the check, because bleeding or a growth can pass for prolapse. Pressure tests and an ultrasound are added only for leakage or blocked emptying.
The full picture of rectal prolapse and its treatment is on our rectal prolapse surgery page. This post explains how the problem is checked, step by step.
Three different stories hide under one complaint. The doctor asks which one troubles you most, because the main symptom changes the plan more than any scan does.
| Main trouble | What we ask about | Where it leads |
|---|---|---|
| Something comes down | A lump when you strain or walk, pushing it back, mucus, bleeding, a feeling of sitting on a ball | Examination, then the choice of repair |
| Cannot empty | Straining, a blocked feeling, pressing on the vagina or near the anus to help, long time on the toilet | Defecography and exercise training for the pelvic floor |
| Leaking stool or gas | Soiling without warning, or a rush you cannot hold, pad use, night leaks | Pressure tests and an ultrasound of the anal muscles |
Most people have a mix of these. Tell us which one you would fix first if you could.
A few details matter more than the rest. They tell us whether to test further, whether to try exercise first, and whether the cause may be something more serious.
The examination is the most useful test. It often settles the diagnosis. For an older, frail person with an obvious prolapse, it may be all that is needed.
| Step | What it shows |
|---|---|
| Looking at rest | A loose anus, skin change, a prolapse already out, a pelvic floor that sags |
| Straining, lying on your side | May bring the prolapse out so we can see it |
| Straining while seated on a commode | Many prolapses come out only upright, and are missed on the couch |
| Looking at the folds | Rings all the way round, with a groove, mean the full wall. Folds like spokes mean the lining or piles |
| Finger examination at rest and squeezing | The strength of the anal muscles |
| Finger examination while you bear down | A tightening instead of a relaxing shows the muscle is working against you |
| Finger in the rectum and vagina together, in women | Size of a bulge into the vagina, and any bowel slipping down behind it |
| Pushing the prolapse back | Whether it can go back. A mass that will not, turns dark or is sore needs care the same day |
| Short scope of the anal canal | A sore or a polyp on the front wall, which is sampled if there is doubt |
If the prolapse will not come out in the clinic, that does not mean it is not there. A photograph taken at home, or defecography, can show it.
Defecography is a moving picture of the rectum and pelvic floor taken while you pass a soft paste. It shows what happens in a real effort that a couch examination cannot copy.
It is private and short. It is not usually sore. Let the team know if you feel shy or anxious, and we will help you through it.
The pictures are read against a short checklist. The grade of the hidden fold is the key finding, but the grade alone never decides an operation.
| Finding | What it means | Effect on the plan |
|---|---|---|
| Hidden fold, grade one to five | How far the folded rectum travels, from inside the rectum to out through the anus | Higher grades with matching symptoms may need an operation |
| Bulge towards the vagina | Its depth, and whether paste gets trapped in it | Repaired only when it is large, traps paste and you press to empty |
| Bowel in the space behind the vagina | Small bowel or sigmoid colon slips down | Favours an operation through the abdomen |
| Drop of the pelvic floor | The pelvic floor sags below its normal level | Points to wide weakness of the floor |
| Muscle that stays shut | The passage fails to open when you push | Exercise training comes before surgery |
| How much empties | Amount and speed of emptying | Poor emptying points to a blocked outlet |
The grade guides us, but your symptoms decide. A high grade in a person with no trouble is often left alone.
No single test answers everything. Each one answers one question. We choose by your main trouble, and skip tests that cannot change the plan.
Two points are not optional. A scope comes first when there is bleeding, weight loss or older age. And a person with a slow colon should not be told that a prolapse repair will ease constipation. It will not.
The tests lead to one of a few routes. An obvious prolapse in a frail person goes straight to a scope and surgery planning. Blocked emptying goes to exercise training first.
Scores for leakage and for emptying are noted at the first visit. They give a baseline, so we can check later how much you have truly improved.
Not always. If the bowel clearly comes out and the examination shows it, scans may add little. Defecography helps when the prolapse is hidden, or when emptying is the main trouble.
It is a moving X-ray or MRI taken while you pass a paste placed in the rectum. It shows how the bowel and the pelvic floor behave when you strain.
It is private, and the team does this all day. It does not usually hurt. Most people find the nervous wait harder than the test.
A growth or polyp can sit at the tip of a prolapse, and bleeding has other causes. The scope rules these out before the problem is called benign.
That is common. We may ask you to strain on a commode, or to photograph it at home. Or we arrange defecography, which copies a real toilet effort.
A thin tube measures how tightly the anal muscles squeeze and relax, and how well you sense a filling rectum. It helps in leakage and in blocked emptying.
They guide it. Your main symptom decides most. A picture with no complaint is often left alone, and some people need exercise training before any operation.
For the whole range of prolapse care, start at the rectal prolapse surgery page. For questions before you travel, call +91-63555-64601.
Dr Harsh Shah — Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Consultations, review of reports and scans, operations and follow-up. OPD Monday to Saturday, 9 am to 5 pm.
Appointments: +91-63555-64601 · +91-63590-11009 · Hospital 079-2663 6363
Directions to the hospital · WhatsApp +91-63555-64601
Something comes down when you strain, or you cannot empty your bowel fully? You do not need to work out the test yourself. Dr Harsh Shah takes the history, examines you and orders only the tests that will change your plan. Call, or send a message on WhatsApp. Call +91-63555-64601 Ask on WhatsApp
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