• Rectal prolapse commonly presents in children
between the ages of 1 and 3 years, with a primary symptom of anal discomfort
or prolapse after defecation; occasionally it may present as bleeding.
• When a prolapse is not immediately present and the child is old
enough to cooperate, diagnosis can potentially be made with the
child squatting or straining on the toilet.
• A glycerine suppository may also aid in the diagnosis.
• Palpate the prolapsed segment between the fingers and thumb to
help differentiate mucosa from full-thickness prolapse.
• Mucosal prolapse tends to have radial folds and full-thickness
prolapse exhibits concentric folds (Table 30–1).
• Differentiate from polyp, which is plum-colored and does not
involve the entire anal circumference.
• Differentiate from intussusception, which on digital examination
allows the examiner to insert between the anal wall and the protruding
mass. With a prolapse, there is no space between the perianal skin
and the protruding mass.