Numerous risk factors are associated with a rectal prolapse.4–11 These include malnutrition, chronic constipation, excessive straining, and diarrheal disorders such as amoebiasis, giardiasis, and other parasitic infections. Rectal prolapse in children is often idiopathic. However, there is an association with paraplegia, meningomyelocele, and pinworms. Anatomic variations such as a vertical course of the rectum, flat sacrum and coccyx, and lack of levator ani support can also result in a rectal prolapse. Children placed on adult toilet seats for prolonged periods of time may develop a rectal prolapse. One of the most serious risk factors for a rectal prolapse in children is cystic fibrosis.6 Patients with cystic fibrosis have an 18% incidence of rectal prolapse. Children with no apparent cause for a rectal prolapse should be considered for a sweat chloride test. In the elderly, rectal prolapse is associated with collagen vascular diseases, malignancy, pelvic floor weakness, mental retardation, organic brain syndrome, stroke, chronic psychiatric conditions, and chronic neurologic conditions (e.g., tabes dorsalis, cauda equina, and multiple sclerosis).5,11 It is important to note that patients with rectal prolapse often present with no apparent causes. The physician should maintain a high index of suspicion for the risk factors mentioned above.