• Most cases of rectal prolapse reduce spontaneously.
• Rarely, a surgical procedure may be necessary to correct a full-thickness
• Rectal prolapse should be promptly reduced to prevent a sustained
prolapse that allows edema to form and potential subsequent venous
congestion and thrombosis to develop, which may lead to ulceration
of the rectal mucosa with bowel ischemia and infarction.
• A rectal examination needs to be performed to differentiate prolapse
from an intussusception or rectal polyp.
• Diagnostic studies are often not necessary, but a proctoscopy,
colonoscopy, or barium enema may be indicated when the patient has
a history of rectal bleeding.
• Children need to be tested for parasites and cystic fibrosis as
well as other causes of anal straining (including neuromuscular
problems, proctitis, and inflammatory bowel disease).
• Presence of nonviable bowel or rupture of rectal
• Child appears toxic (ie, with fever, tachycardia, or leukocytosis).
• Table sugar or salt.
• 6F rectal tube.
• There are very few risks with manual reduction.
• Parents should be informed that prolapse may recur and instructed
on proper technique for reduction.
• Discuss the potential risk of sedative medication.
• Recurrent prolapse or a prolapse that is not amenable to manual
reduction may require operative intervention.
• 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.
Table 30–1. Classification
of rectal prolapse. |Favorite Table|Download (.pdf)
Table 30–1. Classification
of rectal prolapse.
|Characteristics||Mucosal Prolapse||Full-thickness Prolapse (Procidentia)|
|Layers involved||Mucosa only||All layers of the rectum|
|Physical appearance||Rosette appearing with radial folds at anal
junction||Circular folds in prolapsed mucosa |
|May not be seen with significant edema|
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