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  • Most cases of rectal prolapse reduce spontaneously.

  
  

  • Rarely, a surgical procedure may be necessary to correct a full-thickness prolapse.

  
  

  • 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).

Absolute

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  • Presence of nonviable bowel or rupture of rectal mucosa.

  
  

  • Child appears toxic (ie, with fever, tachycardia, or leukocytosis).

Relative

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  • Uncooperative patient.

  
  

  • Questionable viability of bowel.

  
  

  • Mucosal ulceration.

  
  

  • Recent rectal pull-through procedure.

• 
  

  • Gloves.

  
  

  • Lubrication.

  
  

  • 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.